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A SYNOPSIS, 

OR 

GENERAL VIEW 

OF THE PRINCIPAL 

THEORIES OR DOCTRINES 

OF 

DISEASES, 

WHICH HATE PREVAILED OR BEEN TAUGHT AT 
DIFFERENT PERIODS 

TO THE PRESENT TIME. 



BY WILLIAM "CURRIE, 

FELLOW OF THE COLLEGE OF PHYSICIANS OF PHILADELPHIA, 
MEMBER OF THE PHILOSOPHICAL SOCIETY, &c. &c. 



" Nothing extenuate, 

" Nor aught set down in malice " 



PHILADELPHIA 



PUBLISHED BY EDWARD PARKER, If 8, MARKET STREETS 

W. Brown, Printer, Church Alley. 

1815. 



bLoo 



CONTENTS 



Page 
\n Abstract of the Theory of 

Hippocrates ------ 10 

Galen 15 

Willis 29 

Sydenham ------ 30 

Stahl - - - - - - 35 

Hoffman 36 

Boerhaave - -- - - -41 

Sauvages, Vogel, Gaubius, M'Bride, Tode, 

Burserus, and Screta - 43—47 

Cullen 50 

Brown - 63 

Darwin - - - - - - - 87 

Wilson 113 

Rush 119 

Gregory - - - - - - 167 



PREFACE. 

THE Author of the following Synopsis, 
or general view of the theories or doctrines 
of diseases, that have prevailed or been taught 
at different periods, (compiled from the most 
authentic sources) has been induced to pub- 
lish it, from a conviction that a correct know- 
ledge of the nature and proximate causes of 
diseases, or that condition of the system on 
which the symptoms of diseases depend, 
would be of incalculable benefit in conduct- 
ing to safe, and successful practice. And as, 
next to 'peace of mind, reflection upon an in- 
nocent and useful course of life, and a soul 
aspiring after perfection, there is nothing in 
this world more to be desired than health of 
body, and a knowledge of the means best 
adapted to remedy or alleviate the various ills 
of life, he hopes, as he has " nothing exten- 
uated, nor aught set down in malice ;" but 
has reviewed each theory with freedom and 
impartiality, and has endeavoured to the best 



IV PREFACE. 

of his abilities to point out the merits as well 
as the defects of each, that the publication 
taken in the aggregate, will not only contri- 
bute to the entertainment of those that are 
engaged in medical studies, but aid them in 
separating truth from the almost infinitude of 
error with which it is blended. 

The diseases to which the human body is 
liable, are so various, and frequently so com- 
plicated, that it requires great judgment to dis- 
tinguish them with accuracy, as well as a per- 
feet knowledge of the philosophy or laws of 
the animal economy in health and disease, to 
treat them with safety and propriety. A con- 
stant and diligent attendance on the sick may 
instruct us in the external aspect of diseases, 
and enable us with some degree of cerfaiuty 
to prognosticate their issue, but without a 
knowledge of their proximate cause or that 
condition of the system from which the symp- 
toms proceed, such knowledge can never fur- 
nish us with any other than the mere fortuitous 
means of removing them. How blind and dan- 
gerous would be all attempts to cure the dis- 
orders of the eye without a knowledge of its 



PREFACE, V 

m 

structure, and an acquaintance with the the- 
ory of vision ? The empiric, or one who con- 
fines himself entirely to experience and obser- 
vation, regardless of the causes of diseases, 
is ignorant of both. Suppose him consulted 
in a case of gutta serena. No external de- 
fect appears, no pain is complained of, and 
the patient's health in other respects does not 
appear to be impaired. By what symptoms 
will the empirical occulist be able to ascertain 
the seat and immediate cause of the disease, 
or upon what principles will he proceed in 
the treatment of it ? Uncertainty, and conse- 
quently confusion and danger, must necessa- 
rily attend his random practice. By the laws 
of the animal economy, a certain sympathy 
subsists between different parts of the body, 
bv which the disordered state of one or^an 
impairs the functions of another. The head 
and stomach, for instance, have an almost 
universal consent with the rest of the system, 
and of course are subject to various and some- 
times opposite kinds of indisposition; each 
indicating a different and peculiar mode of 
cure. Thus, watching, flatulency, indiges- 
tion, rheumatism, or inflammation, may pro- 

a 2 



VI PREFACE, 

duee the head-ache; and sickness or vomiting 
may arise from surfeiting, from a load of mu- 
cus, or an influx of bile, # or from an affection 
of the kidneys or bladder, and from other 
sources* In all these cases the empiric, or 
mere matter of fact physician, if he acts con- 
sistently with his professions, will attend only 
to the leading symptom, and will indiscrimi- 
nately apply his stomachic cordials, or ce- 
phalic plaster, without any regard to the ori- 
gin, nature, or proximate cause of the disor- 
der. May w r e not, therefore, conclude, that 
mere experience, whether derived from books 
or acquired by observing the rise and pro- 
gress of diseases and the effects of the re- 
medies prescribed, is insufficient of itself to 
qualify us for judicious and successful prac- 
titioners ; and that the theorist, or physician 
who is acquainted w 7 ith the nature and proxi- 
mate cause of diseases, has the same advan- 
tage that the empirical practitioner can boast 
of, from reading, observation, and practice : 
with the additional advantage, of knowing 
on what circumstances the disorder and its 
symptoms depend. 



PREFACE. Vll 

Notwithstanding the necessary conclusion 
from these facts, and although deductions 
from unequivocal facts and self-evident pro- 
positions are the only certain method of im- 
proving any art or science, and though Rea- 
son is the most exalted faculty of man, and 
the source of that high rank which he holds 
above all other animals of the terrestrial globe, 
there are a set of grovelling spirits who vilify 
the powers of the understanding, and with a 
sagacity adequate to the rank of beings to 
which, by their rejection of the aid of reason, 
they degrade themselves, pronounce all theo- 
ry or reasoning on the nature and causes of 
diseases, and the modus operandi of medi- 
cines, useless and unavailing. 

The reader will perceive by the following 
abstract of the theories of fever which have 
been taught at different times, that no theory 
of fever that has hitherto been proposed, is 
true, or in all respects perfect, though some 
of the more modern ones approach near to 
perfection. The failure in this instance ap- 
pears to be owing to the unaccountable inat- 
tention to the rules of inductive philosophy^ 



Vlll PREFACE. 

by which Newton discovered the laws of the 
planetary system, and to the misapplication 
of the erroneous philosophy of former times, 
and to the unfortunate circumstance of phy- 
sicians of eminence in their profession mis- 
taking effects for causes, assuming imaginary 
for the real laws of the animal economy, and 
to their not being acquainted till very lately 
with the want of connection between the 
heart and bfain, and with the important ef- 
fects produced on the condition and properties 
of the blood by the atmospheric air through 
the medium of the lungs. The author there- 
fore hopes that the observations contained in 
the following pages, will contribute towards 
leading the way to the establishment of a 
more improved theory, and consequently to 
a more rational and efficacious mode of prac- 
tice in the different varieties of fever, than has 
heretofore obtained. 



SYNOPSIS, &c. 



x HE most ancient treatise of physic worthy 
of notice, that has escaped the ravages of 
time, and the more destructive hands of bar- 
barians, was compiled between four and five 
hundred years before the sera of Christianity, 
by Hippocrates, a native of the renowned re- 
public of Greece, and a descendant of the 
once celebrated Esculapius, who it is said, 
performed such extraordinary and miraculous 
cures, that his countrymen paid him divine 
honours. 

Before the time of Hippocrates, it appears 
from ancient history, that the healing art con- 
sisted of little else than the most absurd su- 
perstition and quackery, and that remedies 
composed of the most discordant materials, 
in conjunction with amulets, charms, and 
magic spells, or mysterious and magical and 
absurd ceremonies, were employed for the 



10 

cure of diseases, by artful, designing, and 
unprincipled impostors, who pretended " to 
hold converse with the airy tenants of the 
world unknown." 

According to the doctrine or theory of dis- 
eases contained in the works of Hippocrates, 
(whom posterity has honoured with the title 
of Father of Physic, and Prince of Physi- 
cians), the generality of diseases are occa- 
sioned either by a disproportion in the usual 
quantity or a depraved change in the quality 
of the phlegm and of the bile, or of either of 
these excreted humours mixing with the 
blood; and these, in conjunction with too 
great a proportion of atmospheric air contain- 
ed in or introduced into the blood, is the 
cause of the cold fit which precedes a fever. 

We may judge of the correctness of the 
pathology and the qualifications of this " Fa- 
ther of Physic," for explaining the causes of 
the symptoms of diseases, from his explana- 
tion of the rigor and yawning which accom- 
pany the cold fit of an intermittent fever. 

"The former (he says) is occasioned by 
air finding its way into the blood, by which 
it is refrigerated and condensed, in propor- 



11 

tion to the quantity and degree of coldness 
of the air which has gained admission into 
the blood; and a shaking or shivering takes 
place, because nature (which he says is 
something divine, that preserves order in the 
animal ecqpomy in health and restores regu- 
larity to it when disordered,) being alarmed by 
the sense of cold, causes the blood to take re- 
fuge towards the internal and warmer parts of 
the body. Its leapings and boundings make 
the whole body shake or tremble; the places 
which it has deserted shaking for want of it 
to keep them steady, a-nd those to which it 
has run trembling frpjjoD being over distended 
by its quantity, and the force of its influx." 
"The yawning (he imagined,) was occa- 
sioned by the pent up pir, rushing at once 
towards the mouth, and forcing it open, to 
find a passage out." 

Unluckily for the credit of this doctrine, 
it happens, that no experiments have dis- 
covered the existence of atmospheric air in 
the blood vessels; and in the act of yawn- 
ing, the air passes in, instead of out of the 
mouth. 



2 



This doctrine of critical days, Celsus, who 
lived in the reign of Tiberius Caesar, thinks 
he invented from a superstitious or implicit 
attachment to the doctrine of Pythagoras, 
relative to harmonic numbers. 

Hippocrates who appears to have been the 
first founder or promulgator of the doctrine 
that morbific matter, generated in or intro- 
duced from abroad into the circulating fluids, 
was the immediate or proximate cause of all 
febrile diseases; presuming that what he 
calls nature never separates crude matter in 
the beginning of fevers, or while it is blend- 
ed with good juices, he prescribed very few 
remedies, but waited to see what evacuations 
would make their appearance on the days 
that he supposed the disease would come to 
a crisis, (namely, on the 4th, 7th, 11th, 14th, 
17th, and 21st,) but after removing the con- 
tents of the stomach and bowels, by a gentle 
emetic and cathartic, and prescribing rules 
for the regimen to be observed, which he di- 
rected to be of a mild and liquid kind, he 
trusted the management of the disease al- 
most entirely to the economy of nature, and 
waited patiently for a crisis or change for 



13 

..belter or worse ; as appears from bis book 
•De diceta in morbis aeutis." 

The theory or medical philosophy of this 
eminent physician of the ancients, though its 
errors and fallacies are almost self-evident, 
became remarkably popular, and continued to 
bear sway among the most eminent of the 
Greek and Roman physicians for nearly 
three hundred years after the decease of its 
distinguished author, though its merits were 
called in question at different times within 
that period, by the chiefs of two sects or so- 
cieties of physicians known by the names of 
dogmatists and methodists; and in the reigu 
of Tiberius Csesar, Themison, a distinguish- 
ed physician of the methodic sect, ridiculed 
Hippocrates's doctrine of critical days, and 
because he advised physicians to wait and 
observe the way that nature took to relieve 
the suffering constitution from the effects of 
fever, on certain days before they interfered 
with their remedies, which he supposed did 
more harm than good if administered before 
the morbific matter was concocted or ripen- 
ed, so as to be fit to be separated and expel* 

B 



14 

led; he called his practice " A meditation 
upon death. " 

The methodic sect, and Themison in par- 
ticular, reprobated the tedious method of stu- 
dying the symptoms of every individual dis- 
ease, and the effects of every remedy which 
had been sanctioned by time and experience, 
and invented a more easy method of shorten- 
ing the study of medicine. With this view, 
lie divided all diseases into two distinct 
classes, according as the symptoms indicated 
too rigid and tense or too soft and relaxed a 
state of the solids, or an unequal combination 
of these two conditions. 

In the early part of the second century of 
the christian ssra, Galen, who has been much 
celebrated in medical history, and was at the 
head of his profession in the city of Rome, 
undertook to reform medicine, and restored 
dogmatism, (which had been superseded by 
the doctrine of the methodic sect,) though 
the doctrine of the dogmatists consisted of 
scarcely any thing but visionary hypotheses 
or fanciful conjectures, without reference to 
experiments or any alliance with the laws of 
the animal economy, and were involved in 



13 

an impenetrable labyrinth of error and con- 
fusion. He also wrote numerous commenla* 
ries on the aphorisms of Hippocrates, and 
composed several voluminous works of his 
own. 

The theoretical opinions of Galen, in gene- 
ral, agree with those of Hippocrates, but he 
differs from him in extending the noxious 
qualities of the different humours, and in di- 
viding the disordered pulse- into minute and 
almost endless distinctions, which instead of 
instructing only serves to mislead and per- 
plex the student. 

He fancied that the reason why more or 
less feverish heat constantly succeeds an 
ague or chilly fit, is because, the blood after 
some agitation, brings to its own degree of 
heat the liquors or humours that have mixed 
themselves with it, and being thus increased 
in quantity must necessarily produce more 
heat in the body by the friction produced be- 
tween the solids and the fluids." The phleg 
matic and bilious portions of the fluids, rari- 
fied and attenuated by the feverish heat, in 
his opinion, separate themselves from the 



16 

mass, and are expelled on the critical days 
by the efforts of the animal economy." 

Galen and his followers, as well as all the 
physicians of the ancients, appear to have 
believed that animal heat depended entirely 
upon the reciprocal friction of the solids and 
fluids, independent of any chemical change 
produced through the medium of respiration, 

In conformity with his doctrine, the chief 
object of Galen and his followers was to pre- 
vent the heat from being increased by the 
friction, and the blood vessels from being 
ruptured by the rarifaction of the blood; for 
which reason their chief dependahce was on 
copious blood-letting, and the liberal use of 
cold water inwardly. They also favoured 

such evacuations as occurred on the sup- 

«. 

posed critical days, but restrained them 
when they occurred on the intermediate days 
as an erroneous or mistaken propensity and 
effort of nature. 

Galen supposed the lungs were intended 
for ventilators to the heart, that the animal 
heat might thereby be prevented from rising 
to excess. He imagined that air mixing with 
the blood generated the animal and vital 



4 *-* 

spirits. The chyle he supposed was con- 
veyed from the stomach to the liver and 
there manufactured into blood by a species 
of fermentation not understood. But to the 
nerves he assigned their true function, as in- 
struments of sense and motion. He was en- 
tirely ignorant of the laws and principles of 
chemistry, nor did he observe that close 
cautious method of investigating the causes 
of diseases or the effects of medicines which 
has since been recommended by Sir F. Ba- 
con, from facts and experiments, but too 
often contented himself with substituting 
plausible but fallacious conjectures; hence; 
his pompous and chimerical doctrines have 
vanished before a more enlightened philoso- 
phy, "like the baseless fabric of a vision. " 

Notwithstanding the prolixity, incongrui- 
ties, and inconsistencies of Galen's doctrine 
of diseases, it took the lead and kept domi- 
nion over all others, till the Roman empire 
was subverted by the Goths and Vandals in 
the 5th century, which event put almost an en- 
tire stop to the cultivation of literature of every 
description in Europe. From that time the 
study of the arts and sciences was entirely ne=, 

b 2 



18 

glected, and the only knowledge which had 
any relation to medicine that was cultivated, 
till after the revival of literature, which be- 
gan to dawn hi the 11th, but made little pro- 
gress till after the invention of printing in the 
15th century, was judicial astrology or the 
art of predicting future events by certain 
signs supposed to be legible in the stars. 
During that period, many physicians united 
with their profession the occupation of a sor- 
cerer, conjurer, or fortune-teller, and pre- 
tending that they knew the nature of every 
disease from the mere inspection of the urine, 
without seeing the patient, and that they 
knew how to prescribe the most efficacious 
remedies from an examination of the signs 
of the zodiac, they took advantage of the 
credulity of the illiterate, and sported with 
the lives of their fellow creatures for the 
sake of a little filthy lucre, to enable them 
to live in idleness and ease; and by unde- 
tected or tolerated frauds frequently gained 
a palace, when their only title was a gal- 
lows. 

During those dark ages of ignorance and 
credulity, the understandings of many ap- 



19 

pear to have been so much under the domi- 
nion of a misguided or deluded imagination, 
that they believed diseases of particular or- 
gans could be infallibly cured by particular 
vegetables, for no other reason than that 
there was a resemblance between the figure 
of the remedy and the diseased organ, 

Th<* physicians of those ages having ac- 
quired a superficial and incorrect knowledge 
of astronomy, supposed that every mortal was 
under the influence of the particular planet 
that was visible in the horizon at the time of 
his birth, and that his constitution and tem- 
perament partook of the qualities and tem- 
perament of that planet; of course, when 
disordered, medicines of a quality different 
from the temperament of such planet were 
to be employed. They also examined and 
consulted the different signs of the zodiac to 
know when it would be the most proper time 
to perform the common operations of surgery, 
to open a vein, pare a corn, or wean a child, 

A remnant of the same absurd and ridicu- 
lous credulity, the offspring of ignorance and 
want of reflection, I am sorry to say, still 
continues to hold dominion over the minds o£ 



m 

the illiterate and vulgar part of the commu- 
nity in this as well as in other countries. 

If any reliance can be placed on historical 
facts, the physicians of Europe became en- 
tirely ignorant of the nature and causes of 
diseases as well as of the laws of the animal 
economy after the subversion of the Roman 
government in Italy, till in consequence of 
the invention of printing in the 15th century, 
the remains of the literary and scientific trea- 
sures of ancient Greece and Home became 
more generally diffused and sent abroad. 

In consequence of these events, the works 
of Hippocrates and Galen again gained the 
ascendency over the medical world, and their 
rules and precepts once more became the 
standard of legitimate practice. To these 
as to the oracles of reason, every one appeal- 
ed, and these it was the study of every one 
to imitate. 

But after the art of chemistry became cul- 
tivated, and medicines prepared by chemical 
processes were introduced into practice about 
the middle of the 16th century, by Paracel- 
sus, who was born in Switzerland A. D. 
1531, a few physicians of more cultivated 



21 

understandings, began to entertain doubts of 
of the infallibility of those authorities, as 
others did soon after of those who had as- 
sumed the privilege of regulating the faith 
of the christian world, and called in question 
the propriety of paying implicit homage to 
their precepts. 

About the close of the sixteenth century, 
in the reign of Queen Elizabeth, arose that 
great luminary of science, Sir Francis Ba- 
con, afterwards created Lord Verulam, who 
by means of experimental philosophy and in- 
ductive reasoning, invented or discovered the 
only method of acquiring certain knowledge 
in the arts and sciences. 

While the other branches of science Were 
daily improving, id consequence of the adop- 
tion of the plan proposed by the sagacious 
Bacon, Dr. W; Harvey, physician to King 
Charles the First, of England, followed the 
same plan in his anatomical researches, and 
rendered his name immortal by his discovery 
of the circulation of the blood. A discovery 
of infinite service to the art of surgery, in par- 
ticular, and of very great importance to the 
healing art in general. The true kuowledge 



of the circulation had eluded the researches 
and dissections of all Dr. Harvey's prede- 
cessors-, though Michael Servetus, a native of 
Geneva, who afterwards suffered martyrdom 
through the resentment and religious zeal of 
Calvin, on account of his religious opinions, 
appears from his account of the circulation 
of the blood through the lungs, published in 
the year 1533, to have niade very near ap- 
proaches to it.* 

In consequence of this discovery of Dr. 
Harvey, which was first made public in the 
year 1628, the doctrines of the ancients, and 
particularly that of Galen, which had been on 
the decline from the time that chemistry be- 
gan to be cultivated, were renounced by the 
generality of physicians of that period, though 
too many, still governed by habit and the 
prejudices of an imperfect education, prosti- 
tuted their reason to blind authority. 

The knowledge of the circulation of the 
blood, however, did not for a considerable 
time, contribute to advance one of the essen- 
tial objects of medicine, the knowledge of the 

* For an account of the opinions of Servetus, the reader is 
referred to Dr. Priestly's church history* vol. v. p. 454. 



S3 

nature and proximate causes of diseases, so 
much as might have been expected, owing in 
a great measure, to physiologists and physi- 
cians adopting and applying the principles of 
mechanical philosophy to explain the motions 
and operations of the living body; for, it is 
a discovery of a more recent date, that the 
laws which govern passive and inanimate 
matter, are by no means similar to those 
which govern living bodies, and that maxims 
which are true and just when applied to in- 
sensible tubes and inanimate substances, are 
erroneous, and lead to false conclusions, 
when applied to those that are sensible or ir- 
ritable, and are every instant changing their 
areas. The principal defect of the mechani- 
cal doctrine consists in overlooking the great 
influence of the vital principle in every part 
of the animal economy. 

For a number of years after the discovery 
that the blood, passing from the heart w 7 as 
carried by the arteries to all parts of the liv- 
ing system, and that from thence it returned 
to the heart through the veins, the human 
body was considered as a hydraulic machine, 
the good state and preservation of which de- 



m 

pended on the liberty that the blood had to 
pass through all the tubes with which it is 
supplied. The principle of life and health 
being thus founded in error, the loss of the 
equilibrium between the solids and fluids 
and a disordered circulation were looked 
upon as the chief causes of diseases ; the at- 
tention of physicians was therefore directed 
to the too lax or too rigid state of the fibres, 
and to the fluids being in too large or too 
small a quantity for the capacity of the ves- 
sels. In a word, the physicians of that pe- 
riod considered the living body to be a mere 
hydraulic machine, provided with mechani- 
cal instruments, including pullies, levers, 
pumps, suckers, bellows, strainers, &c. ; and 
they imagined that the fluids of the human 
body ascended and descended by the power 
of gravitation, as well as by a vis a tergo 
and contractile power of the heart and arte- 
ries. They were acquainted with no argu- 
ments but numbers, and with no proofs but 
algebraical calculations. Thus, by applying 
the laws of mechanics to explain the motions 
and operations of the animal economy, the 
discovery of the circulation for a time, in- 



25 

.stead oT leading to correct views, became the 
source of dangerous errors in the theory and 
treatment of diseases. 

This, among others, is a strong evidence 
of the injurious practice which must necessa- 
rily be the consequence of adopting an erro- 
neous theory, and of the great importance of 
acquiring a competent knowledge of the na- 
ture and proximate causes of different dis- 
eases. 

Other professors, about the same time, 
joining chemistry to mechanics, taught among 
other errors, that all fevers were occasioned 
by certain minute substances with rough or 
angulated surfaces or sharp points, in the 
shape of triangles, introduced into or gene- 
rated in the blood, in consequence of the ope- 
ration of certain remote causes suppressing 
or obstructing some of the natural and cus- 
tomary secretions, or occasioning a retention 
of the substances which ought to be secreted, 
and that the fulness, heat, or acrimony, 
jointly or severally, proved direct stimulants 
to the heart in the course of the circulation; 
and for the cure of the diseases, they pre- 
scribed such medicines as they fancied were 

c 



adapted to -soften, obtund, and render these 
little wedges and sharp pointed substances 
soft and globular, and thus fit them to be ex- 
pelled from the circulating mass by what 
they called an effort of nature. 

For some time after the introduction of me- 
dicines prepared in the laboratory of the che- 
mists, which were brought into practice by the 
.enthusiastic Paracelsus, about the year 1547? 
who appears to have been fanciful and enthu- 
siastic in his theories, bold in his practice, 
and rashly confident in his means : the profes- 
sors, who, agreeably to the fashion of the 
day, devoted much of their time to the study 
of chemistry, to the exclusion of the other 
branches of medical knowledge ; and particu- 
larly, after the improvements made by the 
noted Vanhelmont, several years later, came 
to be publicly known, appear to have been 
sq much under the influence of a chemical 
jnania as to consider the human body similar 
to an alembic; and fancying febrile diseases 
to be owing to an excess of fermentation, 
among the particles of which the fluids of 
the human body are composed, they had re~ 
£Qurse to such remedies as they had observed 






to bate the effect of subliming or precipi- 
tating portions of different compositions in 
their retorts J and mistaking the coagulable 
lymph or gelatinous substance which covers 
the crassa men turn of the blood in diseases 
depending on inflammatory affections, for 
crude and indigested morbific matter, they 
took great pains to prevent the febrile heat 
from being reduced so low as the usual tern- 
peratu re in health, lest its fermentation and 
maturation should be prevented or retarded, 
Riverius, physician to King Henry the 
Fourth of France, and cotemporary with Sir 
Theodore Mayerne, who was afterwards 
physician to King Charles the First of Eng- 
land, w as so much influenced by the hypo- 
thesis or false philosophy of the time iri 
which he lived, that in cases of small pox, 
he advised the air to be excluded from the 
chamber of the patients, and (heir beds to 
be covered with red cloth, •'• because thatco- 
r bv some affinity with the red and boil- 
log blood, attracts it to the external parts.** 
He says ''-'it is also cu-iomary to keep a 
sheep in the chamber, or on the bed near the 
patient, because these creatures are easily 



28 

infected, and draw the venom to themselves 
by which means relief is given to the sick." 
The prescriptions of both the physicians 
above mentioned, in general, contain such a 
number of heterogeneous and discordant ma- 
terials, that they have more resemblance to 
the compositions of the witches in Macbeth 
than to the prescriptions of rational and re* 
gularly bred physicians. 

Such was the astonishing credulity in 
those times, even of men who devoted much 
of their time to the arts and sciences, and 
such has ever been the rage for the marvel- 
lous with the illiterate, that a belief was pre- 
valent that the mere application of the hand 
of a king or queen (to which superstition had 
assigned divine power,) to scrofulous tu- 
mours, would effectually disperse them: and 
that touching warts, corns, and other excres- 
cencies with a dead man's hand, or a piece 
of the flesh of an animal recently killed, and 
afterwards buried, would produce a si- 
milar effect. This was supposed to be 
owing to some sympathizing or subtile oc- 
cult connecting principle, existing between 
the decaying substance and those excv 



9 



pencies with which it had been iu contact, — • 
in consequence as the one decayed the otket 
followed its example. 

A remnant of the same credulity, super* 
stilion, and propensity to the marvellous still 
continues to exist at the time of my writing 
this; especially among those whose minds 
have not been enlightened by scientific cul- 
ture, of which we have had recent examples 
in Mesmer's Animal Magnetism, and Per- 
kins's Metallic Tractors.* 

Some of the professors of that age, and 
among others, Doctor Thomas Willis, co- 
temporary with Sydenham, and a professor 
of considerable celebrity in the university of' 
Oxford, where students are still taught "by 
rule to stray/? (an English translation of 
whose works were published in the year 
1684.) was of opinion that febrile heat was 
occasioned by a collision of nitre (which he 

* In May }682, notice was given in a London Gazette, that 
as the weather was" growing warm, his Majesty would not ; 
touah any more for the king's evil, till after Michaelmas ; and 
in- 1687, an indigent citizen of New Hampshire, having tried 
t\Qvy other means without effect, petitioned the Legislature 
for aid to transport him to England for that efficacious rerrce-" 
dy, Massachusetts Medical Communications, vol 



30 

supposed was contained in and separated 
from the atmosphere by the lungs,) and sul- 
phur, which -he supposed was one of the ele- 
ments or constituent principles of blood. 

The sagacious and highly celebrated Dr. 
Thomas Sydenham, who published his ob- 
servations on diseases in the year 1685, 
which are chiefly valuable on account of the 
accurate description which he has given of 
the symptoms of those diseases that occurred 
in his own practice, influenced by the opi- 
nion of the ancients, and particularly by that 
of Hippocrates, though he disclaims all in- 
struction or assistance from the works of 
others, adopted the doctrine, that morbific 
matter is the immediate or proximate cause 
of every form of fever unconnected with lo- 
cal inflammation. The remote or generating 
causes he supposed were indigestible or un- 
wholesome food, impure water, the suppres- 
sion of perspiration from cold and moist air, 
and the subsequent operation of unusual heat, 
and particularly, some supposed, (for he kas 
offered nothing in proof of his opinion) mys- 
terious and occult change in the constitution 
of the atmosphere, by some inexplicable ope- 



31 

ration of certain planets, comets, or the erup- 
tion of \ ol anoes, &c. 

According to his theory, when any foreign 
and ftoxious matter was introduced into or 
was generated in the blood, for want of re- 
gularity in the secreting vessels and the ex- 
cretory ducts, it occasioned a fermentation si- 
milar to that of vegetable juices in the for- 
mation of vinous liquors. The preternatural 
heat he attributed to an effort of nature, or a 
salutary operation of the animal economy, to 
ripen and prepare the morbific matter, so as 
to fit it for separation and expulsion from the 
circulating fluids. 

The opinion of this worthy but mistaken 
physician, relative to confining the use of 
purgatives and diaphoretics to the critical 
days of Hippocrates, and of restricting bleed- 
ing in pleurisies and other fevers depending 
on local inflammation, to the first week of 
the disease, and with respect to the length 
of time that the crude morbific matter requires 
to become ripe and fit for expulsion, and re- 
lative to intermitting fevers generally ceasing 
spontaneously, without the aid of art, after 
the fourteenth paroxysm, must appear ex- 






tremely fanciful, and objectionable to every 
one acquainted with the more recent improve- 
ments in meteorology,- and the effects of sea- 
son, eliniate r soil, and other local circum- 
stances; as well as ills doctrine relative to 
certain noxious changes in the constitution 
of the atmosphere being necessary for the 
propagation and spreading of contagious dis- 
eases, as well as of those which depend on 
season, soil, or local circumstances,— such 
as intermittent fevers, and dysenteries, du- 
ring the continuance of which insalubrious 
change in the constitution of the atmosphere, 
they would prevail and spread, independent, 
or without the aid of season, situation, tem- 
perature, or other sensible qualities of the 
air; which insalubrious change in the consti- 
tution of the air, he ascribed to eruptions, 
and noxious exhalations from the bowels of 
the earth, or to -the baleful influence? of the* 
planets. 

The seasons at London have undergone ■ 
little or no change for many ages, as has 
been proved from the testimony of medical 
writers of the seventeenth century, especially 
of the elegant Claromontius. The same vi- 



33 

ciSfeitudes of temperature, and the same seve* 
rtty of the vernal months, were then as much 
the topics of complaint as they are at present. 
Yet we now find that the order of the sea- 
sons, in respect to the production of diseases 
is nearly reversed, in consequence of the im- 
provements which have been made in the 
structure of the houses, the arrangements of 
the streets, and in the police of London, al- 
though the character of the seasons continue 
the same. Formerly, it was "saluberri- 
mum ver; autumnus longe periculosissimus ; 
hut now it is the reverse. The inference 
from these data, is obvious, by this ; that 
the constitution of the atmosphere, as to heat 
and cold, dryness and moisture, which the 
changes of season occasion, is not the source 
of epidemic diseases; and that the alteration 
in the condition of the air, which formerly 
rendered it the pregnant cause of disease and 
death, especially in the autumnal months, 
was not any occult intestine changes in the 
constitution: not any general contamination 
brought from afar; not any change from the 
attraction or repulsion of hostile planets, or 
noxious impregnations from the eruptions 



m 

and exhalations of distant volcanoes; hni 
an impregnation received upon the spot — a 
noxious exhalation which that portion of the 
superincumbent air imbibed from the soil, 
and the impurities of animal and vegetable 
substances left upon its surface to putrefy, 
and to the impurities secreted and excreted 
from living bodies, suffered to accumulate in 
unventilatcd situations.^ See Annual Med. 
Review and Register for the year 1801). 

After the publication of the medical works 
of Sydenham; and the observations and opi- 
nions of Baglivi, professor of anatomy and 
physic at Rome, in the year 1696, a humo- 
ral; in conjunction with a chemical pathology, 
continued to he the most prevalent doctrine 
till about the beginning of the eighteenth 
century, when Dr. Stahl, professor of the 
practice of physic in the university of Halle, 
in Germany, introduced a doctrine of a very 
different character from any that had pre- 
ceded that period. 

According- to the system of this professor 
"the motions and functions of the human 
body are governed entirely by the rational 
soulj to many of the motions of which it i* 



35 

not conscious, owing (as Dr. Stahl supposed) 
to a habit of action, and not to the physical 
mechanism and irritability of the living so- 
lids. The soul being extended through the 
medium of the nerves to all parts of the body, 
perceives every noxious impression or disor- 
der that occurs in the system, and like a faith- 
ful guardian calls such powers of the system 
into action, as are qualified to remove or ob- 
viate the noxious impressions, and to preserve 
its salutary operations." 

This fanciful system was not only adopted 
by the whimsical and unreflecting members 
of the profession, as is usually the case with 
every thing that is novel and mysterious, 
however absurd and unintelligible it may be, 
but, in part, by several physicians, distin- 
guished for their erudition, in France and 
Great Britain, as well as in Germany ; though 
the mathematical system of pathology, as ex- 
plained by Bellini, was supported by Simp- 
son, Perrault, Nichols, and many others. 

Junker defended the system of Stahl, and 
some traits which favour the same doctrine, 
may be seen in the works of the late learn- 
ed Gaubius of Holland. 



aS6 

This metaphysical system, however, which 
favoured an inert practice, and taught to com- 
mit the cure of all diseases to the care and 
management of the soul, soon fell into dis- 
credit with most of the practical physicians, 
and only continued to maintain its reputation 
with a few superficial enthusiasts and inex- 
perienced theorists. 

The next system of any note that attract- 
ed the attention and admiration of the medi- 
cal world, was that of Dr. Frederick Hoff- 
man, professor of physic in the same univer- 
sity as Dr. Stahl. 

The theory of this distinguished professor 
was erected on a very different foundation 
from those of any of his predecessors. From 
this system, it appears that Dr. Hoffman was 
the first who discovered, that the generality 
of diseases, and that fevers particularly, have 
their seat in the solids, instead of the fluids 
of the human body, though according to Dr. 
Ferriar the opinion had been suggested some- 
w r hat earlier by Dr. Piens. Professor Hoff- 
man, however, still admitted the agency of a 
depraved state of the fluids; and even sup- 
posed them to be in a state of putrefaction in 



37 

some instances. By blending and retaining 
too much of the mechanical cartesian and che- 
mical rules of explanation in his system, and 
allowing them to influence his reasoning and 
his practice, he has disfigured and rendered 
it confused and untenable. 

The learned and experienced author, not- 
withstanding the liberality of his education 
and the extensiveness of his acquirements, 
appears to have retained too much of the 
early impressions of the nursery, and to have 
suffered himself to be too much influenced by 
superstitious and vulgar opinions, as is evi- 
dent from a chapter in his works on diseases 
occasioned by Witchcraft, or the operation 
of supernatural agents, for the removal of 
which he has given very grave and circum- 
stantial directions. The opinion of superna- 
tural agency in the production of certain dis- 
eases, and of those of the convulsive land 
in particular, was in former ages very uni- 
versal — the invention of importers, or the 
suggestions of a disordered and deluded ima- 
gination; but the error having since been dis- 
covered, in consequence of more accurate en- 
quiries and a more improved state of philo- 

D 



38 

sophy, it is at present deservedly ridiculed 
as the phantom of a weak and disordered 
-mind, or as the base and execrable invention 
of artful and designing imposters and moun- 
tebanks to deceive and mislead the ignorant 
and credulous populace. 

Hoffman, however, was the first that pub- 
licly dissented from, and exposed the errors 
of the humoral pathology, or the long esta- 
blished doctrine of morbific matter, being the 
proximate cause of fever; and expressly 
taught that fevers depend upon diminished 
.power in the nervous system, and of course, 
led the way to a more correct and rational 
theory, or one more compatible with obser- 
vation than any that had been attempted be- 
fore his time. 

In his opinion, < ; a]l diseases are attended 
with irregularity of action, or a suspension 
of all action; and when this irregularity of 
action is too violent, either spasm or convul- 
sion is the consequence, and when weaker 
than natural, atony or weakened contraction 
of the muscular fibres, is the effect." He 
also taught that the treatment of diseases 
was to be improved, not so much by expe- 



rience, as by the skilful application of me- 
chanical principles, and by the sedulous 
study of their nature and proximate causes. 
According to his theory, the proximate cause 
of every form of fever is a spasm or constric- 
tion of the capillary or minute arteries, at tho 
surface of the foody, both internal and exter- 
nal; in consequence of which, he supposed 
the blood was repelled and conveyed in an 
unusual quantify to the heart, and that it was 
thereby distended, and excited to more fre- 
quent action, till it o'vercame the resisting 
and irritating cause. He also attempted to 
account for the symptoms of inflammation on 
the same principles. Owing, however, to 
the circumstances already mentioned, he does 
not appear to have applied his theory in the 
treatment of diseases with that judgment and 
effect, for which, if it had been perfectly cor- 
rect, it was adapted. 

Before the svstem of Hoffman became ze- 
nerally known, its lustre wa-s not only eclips- 
ed, but it was almost entirely superseded 
for a considerable length of time, by the 
more captivating; and, on a superficial view, 
the more plausible system of the celebrated 



40 

Boerhaave of Leyden, which was afterwards 
extended and explained in eighteen octavo 
volumes, by the Baron Yanswieten, physi- 
cian in chief to the Empress of Germany. 

The, following is the substance of the re- 
marks of Dr. Cullen on the Doctrine of the 
last mentioned learned and distinguished 
professor, viz. "What Dr. Boerhaave has 
offered on the diseases of the simple solid, 
has the appearance of being very clear and 
consistent, and was certainly considered by 
him as a fundamental doctrine; but in my 
opinion, it is neither correct, nor extensively 
applicable. Not to mention the useless and 
perhaps erroneous notion of the composition 
of earth and gluten, his mistake respecting 
(he structure of compound membranes, or his 
inattention to the state of the cellular texture, 
all of which render his doctrine imper- 
fect.™! shall insist that his doctrine is very 
little applicable towards explaining the phe- 
nomena of health and disease. The state 
of the simple solid is upon few occasions 
either changed or changeable, but the phe~ 
nomina attributed to that change, do truly 
depend on the state of the nervous and mus- 



cular solids, as has been satisfactorily proved 
by the experiments and observations of Baron 
Haller. How much this shews the deficien- 
cy and imperfection of this system requires 
no explanation." 

"Having considered the diseases of the 
solids, Professor Boerhaave proceeds to ex- 
plain the more simple diseases of the fluids."* 

I need not give a circumstantial detail of * 
the well known facts and arguments which 
have been published by Dr. Cullen and 
others to prove the error of the Boerhaavian 
doctrine, which assigns a morbid state of the 
circulating fluids, as the proximate cause of 
febrile diseases, or to prove the gross error 
of the humoral pathology, or of inflammation 
depending upon the escape of globules of 
blood, and getting as it were by mistake into 
vessels of a different order, whose diameters 
are too narrow to allow them a free passage. 

The experiments of the late ingenious Mr, 
Hewson of London, father of the worthy and 
much respected Dr. Thomas T. Hewson of 
Philadelphia, furnish the most convincing 
proofs that no such lentor or viscidity is con- 
tained in the blood as described by Boer- 

d 2 



haave in cases of fever depending on inflam- 
mation of any particular viscus, but on the 
contrary, the blood is in a state of greater te- 
nuity and fluidity, and the size or gelatinous 
substance which is observed to cover the 
crassamentum of blood drawn in such cases, 
after it has remained in a bowl till cool, is 
only the natural coagulable lymph, which* 
being specifically lighter than the red glo- 
bules, and separated from the rest of the 
mass by the strong and repeated contraction 
of the heart and arteries, and the slower 
coagulation of the blood in such cases, rises 
to the surface unmixed with the red glo- 
bules. 

Sauvages, Vogel, Gaubius, and other sys- 
tematic writers have attempted, in their sys- 
tems of nosology or methodical arrangement 
qf diseases, to unite the doctrines of Hoff- 
man and Boerhaave, in their explanations of 
the proximate causes of diseases, and have 
been followed by the late Dr. David M'Bride 
of Dublin, in his "Introduction to the Theo- 
ry and Practice of Medicine," and by Dr, 
John Baptist Burserius De Kanifeld, profes- 
sor of physic at Milaa in Italy, the last men- 



i 
43 

tioned of whom, published his "Institutions 
of the practice of Medicine" three or four 
years after the publication of Dr. Cullen's 
'•First Lines." 

The doctrine of Professor Boerhaave had 
gained such dominion over the understand- 
ings of the generality of physicians in Eu- 
rope, and particularly in Great Britain, be- 
fore the time of Dr. Cullen, that not only 
the experienced Huxham, but even Dr. 
Mead, the most accomplished scholar of the, 
last age, so late as the year 1750, was so 
convinced of the truth of this doctrine, and 
his judgment was so much perverted by its 
plausibility, that he fancied, in a case in 
which the patient speedily recovered after 
the application of the lungs of a lamb to his 
head, that the morbific matter issued through 
the pores of the skin from the part where 
the lungs were applied.* 

Doctor Tode, a professor in the universi- 
ty of Copenhagan, the capital of Denmark, 
who published his opinion in the year 176i>, 
eight years before the publication of Dr. CuU 
len's First Lines, considers the proximate 

• See Mead's Medical Works published in 1767. 



44/ 

cause of fever to b^ ah increased action or 
exertion of the sensorium, communicated in 
different ways to all the other parts of the 
body, and says " the difference in the phe- 
nomena or symptoms of fevers, depends upon 
the greater or less power of the sensorium, or 
on its greater or less sensibility or susceptibi- 
lity to the impression of irritating or stimulat- 
ing agents; the symptoms in the former case 
being inflammatory, in the latter, nervous or 
accompanied with symptoms of defective 
power in the sensorium, and the organs de- 
pendent on its influence." 

As the accession or cold stage of fever 
cannot be explained or accounted for on this 
doctrine, or on the one lately published by Dr. 
Clutterbuck, who refers all the phenomena 
of fever to a manifest or latent inflammation 
of the brain, it would be time misemployed 
to take any notice of them. The perusal of 
Dr. Cullen's remarks on the different theo- 
ries of proximate causes, which had existed 
before the publication of his works, will 
satisfy the reader, that all such doctrines as 
refer the proximate cause of febrile diseases 
to direct stimuli alone, are erroneous. 



43 

The following are a few of the numerous 
instances of the deplorable effects of the prac- 
tice to which all the theories of fever led, 
which prevailed at different periods, pre- 
vious to the publications of Hoffman and the 
lectures of Dr. Cullen. 

Dr. Silvius having been misled by the doc- 
trine that the coagulation of the blood is the 
proximate cause of fever, banished bleeding 
and cooling remedies from the cure of fevers, 
and recommended spirituous and volatile 
substances to dissolve the supposed coagula- 
tion. Dr. Gilchrist and other physicians of 
Great Britain, employed mercury for the 
same purpose, though its invariable effect is 
to produce the very circumstance which they 
employed it to remove. They appear to 
have fallen into this pernicious error, in con- 
sequence of a hypothesis engendered in their 
own minds, from neglecting to ascertain the 
existence of the fact before they drew their 
conclusions. 

Sydenham, Baglivi, Boerhaave, and Mead, 
with a numerous host of servile followers, 
considered a fever not as a disease, but as 
the remedy of a disease, called up by nature 



46 

almost exclusively for the purpose of throw- 
ing out peccant or morbific matter, blended 
with the circulating fluids. For this reason, 
their chief aim was to regulate the heat, and 
the excessive or defective motion of the 
blood, till the morbific matter had time to 
ripen and become fit for expulsion. For 
the same reason they were very reserved in 
the use of the lancet after the first two or 
three days, even in cases of pleurisy, except- 
ing when the blood was covered, after stand- 
ing to cool, with a thick sizey surface, by 
which they were priucipally guided in the 
repetition of bleeding, from mistaking an ef- 
fect for a cause, instead of by the greater or 
less strength of the heart and arteries as in- 
dicated by the pulse, heat of the skin, &c. 
They also prohibited purgatives in the early 
stage of all fevers, as well as all other' de- 
pleting remedies, excepting a mild emetic 
and purgative at the commencement of the 
disease, to carry off the contents of the primse 
vise, from a belief derived from their theory 
that they would prevent or retard the concoc- 
tion or ripening of the morbific matter; and 
in cases of inflammation, that they would 



47 

only evacuate the thinner or watery portion 
of the blood, a id leave the remainder 
thicker. 

Henry Screta, reviving the opinion of Dio- 
des, derives all fevers from an inflammation 
of the viscera, and from a supposition that in- 
flammation is owing to an obstruction of the 
blood in the small vessels, from its too great 
viscidity, by which it is hindered from pass- 
ing through them; he condemns bleeding, 
purging, and all remedies that diminish the 
febrile heat, as well as those that carry ofif 
the thinner parts of the blood, lest it should 
leave the remainder thicker and more gluti- 
nous, but proposes to cure them by spirituous 
volatile alkaline and saponacious remedies, 
by which means lie expected to dissolve and 
discuss the thick obstructing portion of the 
blood, which only existed in his own bewil- 
dered imagination. 

Some of the over wise gentlemen of the 
faculty, adopting the cartesian philosophy, 
imagined that fevers were occasioned by an 
obstruction of the blood itself, and not of the 
blood vessels, in consequence of which, the 
subtile or spirituous matter, which they sup- 



48 

posed, was constantly ranging through the 
blood with great celerity and passed through 
its pores in straight lines, excited a violent 
commotion in it, in order to recover its cus- 
tomary course. 

Consistently with this hopeful theory, their 
chief remedies consisted in the liheral use of 
warm water to dilute and dissolve the ob- 
structing glutinous matter with which they 
imagined the pores of the blood was plugged 
up. 

Others imagined that all idiopathic fevers 
were the effect of more or less putrefaction 
of the circulating fluids, and being misled 
from observing that the putrefaction of dead 
animal substance* is increased by mois- 
ture, forbid their patients from drinking wa- 
ter, either cold or warm, for the first three 
days, lest it should increase the supposed 
cause of the disease. By this preposterous 
treatment u the patients frequently suffered 
more by the doctor than by the disease/' 

If Mr. Malthus, the author of several in- 
genious tracts on political economy, had 
been acquainted with the hopeful doctrines 
and random practice of physicians, general- 



*9 

]y, from the time of the conquest of the Ro 
man empire in the sixth to the close of the 
seventeenth century, I fancy he would not 
have considered the introduction of the small 
pox into Europe, war, famine, pestilence, 
and typhus fever, as the only instruments in 
the appointments of Providence for prevent- 
ing the population of the world from becom- 
ing too great for the means of subsistence. 

When Dr. Cullen had exposed the errors 
and defects of the Boerhaavian doctrine of 
diseases, and had shewn that the ancient and 
venerable doctrine of morbific matter, which 
originated with, or was adopted by Hippo- 
crates, and which, like a solid body falling 
from a great height, seemed to acquire addi- 
tional force as it descended through admir- 
ing ages, was merely hypothetical or conjec- 
tural, and had resulted from mistaken facts, 
and imperfect observations ; and that as it 
had no alliance with nature or truth, it had 
a tendency to lead to wrong and dangerous 
practice, he found it incumbent upon him to 
compose a new system to supply the place 
of those which he had exposed and demo- 
lished, for the instruction, as well as enter- 

E 



50 

tainment, of the great number of medical 
students that attended his lectures in the 
university of Edinburgh, where he was ap- 
pointed to the professorship of the theory 
and practice of physic. 

Such a system he accordingly composed, 
and afterwards published in the year 1777? 
under the title of "The First Lines of the 
Practice of Physic." The substance of his 
doctrine I shall now proceed to examine. 



Observations on the doctrine of the inge- 
nious and celebrated Dr. Wm. Cullen. 
Professor, 8£c. 

Doctor Cullen improving on the hints and 
opinions of Hoffman, reasonably concluded 
that we are to look for the origin and seat of 
diseases, not in the ideal habitations of hu- 
mours and animal spirits, not in the chemi- 
cal changes or fermentations of the blood, 
but in the solids of the human system, and 
that the true knowledge of the nature and 
proximate cause of diseases, must be de~ 



51 

rived from a knowledge of the causes of the 
motions and functions of the human body in 
a state of health, and of the causes of the de- 
viation or disorder of these motions and 
functions, when disease exists; and his ob- 
serving and penetrating mind was soon con- 
vinced, that the generality of diseases de- 
pend upon the morbid state of the nervous 
and muscular portions of the solids, and that 
the disordered condition of the fluids in the 
generality of the fevers that occur, is the ef- 
fect of too strong or of too weak action of 
thp hpnrt and arteries on the blood, and sel- 
dom, if ever, the effect of morbific matter in- 
troduced into it, excepting when occasioned 
by certain specific contagions, which operate 
not only in producing too high or too low ex- 
citement of the sensorium and nerves, but 
in impairing the vital principle, or principle 
of excitability in every other part of the sys- 
tem ; and especially, as observed by Dr. 
Milman, in the muscular fibres of the heart 
and arteries. 

Thus we perceive that the fundamental 
part of this doctrine is, in many respects, 



m 

different from all that preceded it, with the 
exception of that taught by Dr. Hoffman. 

Dr. Cullen's systematic arrangement of 
diseases into classes, orders, genera, species, 
and varieties, is perhaps too artificial and 
complicated, and not so useful as if he had 
divided all idiopathic, i. e. all diseases in 
which the whole system is more or less dis- 
ordered, only into genera and species, or into 
species and varieties.* 

His histories of diseases are inimitably ex- 
plicit and correct. He even excels the acute 

and celebrated Sydenham, in his description 

of the diagnostics, or those symptoms by 
which each form or variety of disease is dis- 
tinguished from every other. 

The accuracy and comprehensiveness of 
his definitions are peculiar to himself and 
stand unrivalled on the records of medicine. 
The generality of his practical rules are 
selected from his own extensive experience, 

Dr. Thomas Young, physician to St. George's hospital, has 
lately published an improved system of nosology, in which he 
has not only rejected the most exceptionable parts of Dr. Cul- 
lers nosology, but has added Dr. Wiiian's valuable nosology 
of the diseases of the skin. 



., 



53 

and the experience of the most judicious and 
successful of his coteniporaries, and will re- 
main an invaluable treasure to the medical 
profession through successive ages. 

Even the theoretical part of Dr. Cullen's 
system, though by no means faultless or free 
from imperfections, .must be considered as a 
prodigy of ingenuity, when the difficulties 
which he had to encounter are taken into con- 
sideration. 

Truth, however, constrains me to ac- 
knowledge, that notwithstanding the judi- 
cious plan which Dr. Cullen adopted and 
improved, for investigating the proximate 
causes of diseases, or that condition of the 
living system on which the symptoms of dis- 
ease depend, by collecting and tracing ef- 
fects to their causes, he has fallen into seve- 
ral mistakes; and in some instances," in my 
opinion, very considerable ones. 

Some of these I shall now proceed to enu- 
merate, that they may serve as beacons, to 
guard others from falling into the same er- 
ror. 

The first error that occurs in Dr. Cullen's 
arrangement of diseases is, I conceive, that 

e 2 



54 

of classing them according to their symptoms, 
instead of according to the similarity of their 
nature and proximate cause. For, it is well 
known, that diseases the most dissimilar to 
each other in their nature and proximate 
causes, have similar symptoms. The inter- 
mittent fever and the typhus, the proximate 
cause of the former of which appears, from 
the symptoms and the effects of the occasion- 
al cause, to be a certain degree of debility or 
impaired energy of the nervous, and preter- 
natural irritability of the arterial system; and 
in the latter, an impaired state of the muscu- 
lar fibres of the heart and arteries, in con- 
junction with nervous debility, he has placed 
in the same order and genus with fevers ac- 
companied with, and dependent chiefly on, a 
local inflammation of one or more of the vis- 
cera. 

The cyanehe maligna, or putrid and ulce- 
rous sore throat, he has placed in the same 
class with the highest of all inflammatory 
affections, the phrenitis, pneumonia, carditis, 
ententes, &c. 

The small pox and measles, which are 
generally attended with strong action and ia* 



55 

iiammatory symptoms, during the eruptive fe- 
ver, are placed in the same order as the pesti- 
lence, the most debilitating and malignant of 
all diseases ; because the latter is attended with 
glandular swellings and carbuncles, or gan- 
grenous eruptions. The cyanche tonsillaris 
he has classed with the cyanche maligna, 
because the tonsils and fauces in both, are 
affected with swelling and inflammation, 
though proceeding from different causes, and 
entirely differing in their nature, and requir- 
ing remedies of a different kind. 

He has also committed an inconsistency 
in arranging pyrosis, diarrhoea, and diabetes 
in the same order (viz. spasmi) with pertus- 
sis, cholera, asthma, and hydrophobia; and 
in the same class (neuroses) apoplexy, and 
hypochondriasis; while menorrhagia, haema- 
temesis, and hsemorrhois are arranged in the 
same order with typhus, pneumonia, and 
dysentery. 

These instances are sufficient ta shew, 
that attention to symptoms alone, without a 
competent knowledge of the nature and im- 
mediate cause of each individual disease, is 
insufficient, and often tends to lead to false 



^ 



56 

associations, and consequently, to erroneous 
and hazardous practice; whereas, an ar- 
rangement according to the nature and proxi- 
mate causes of diseases, where these can be 
discovered with certainty, is not liable to 
such error and confusion ; and it ought to be 
the object of classification to render the. ac- 
quisition of knowledge certain, easy, and of 
practical utility. 

Doctor Cullen has also incorporated with 
his system, two opinions, one of antiquity, 
the other of more modern date, both of which, 
in my opinion, disfigure its harmony and sim- 
plicity, viz. the doctrine of critical days in 
continued fever, and that of the vis medica- 
trix naturce, or what he calls a law of the 
animal economy, whereby motions are ex- 
cited to resist and remove noxious or inju- 
rious impressions ; both of which have been 
combatted, though not with becoming tem- 
per, nor in the mild spirit of philosophy, by 
the late Dr. J. Brown, of Edinburgh, and 
more recently, with the becoming spirit of a 
candid and sincere inquirer after truth, by 
Mr. John Burns, of Glasgow, in the first 
volume of his dissertations on inflammation. 






57 

According to the Cullenian doctrine, as ob 
served by Air. Burns, "fever is not produced 
directly, by the application of hurtful agents, 
but by the supposed interference of the vis 
medicatrix, or healing power of nature." 

That Dr. Cullen has been led into mis- 
takes by the abstract consideration of symp- 
toms, appears to me evident, from the proxi- 
mate cause he has assigned to every variety 
of fever and inflammation; and from his 
placing fevers depending on local inflamma- 
tion, in the same class and order with those 

that arc idiopatliic 7 and that originate frOIX^ 

and depend upon, a different cause. 

The evidences which he adduces in sup- 
port of his opinion are, that in both the idio- 
pathic or simple fever, and fever depending 
on inflammation existing to a certain extent, 
in some part of the system, there is a dry 
hot skin, thirst, and a decrease of the seve- 
ral excretions. 

These symptoms, however, in case of 
fever accompanied with, and depending on 
local inflammation, cannot depend on spasm, 
which unquestionably requires a part to be 
in a state of debility, in conjunction with 



m 

preternatural excitability of the vessels or 
fibres of the part affected, or acted upon, by 
stimuli dis proportioned to the morbid state 
of excitability, but upon preternatural ful- 
ness and distension, and increased action of 
the arteries of the affected part, and conse- 
quent pain and irritation, &c. ; for "the ge- 
neral operation of all powers productive of 
inflammatory diathesis, proceeds upon prin- 
ciples that would remove the atony or defect 
of power subsisting in the extreme ves- 
sels, which Dr. Cullen considers as the im- 
mediate Cause of spasm in eaeps of favar • 

whereas, the remedies employed to remove 
the arterial tension and inflammation, would 
necessarily increase and fix a spasm. " 

If the remote causes of fever "produce a 
sedative or debilitating effect, (as taught by 
Dr. Cullen,) upon the nervous system," this 
state of debility, in connection with the usual 
excitability which exists in the arterial sys- 
tem at the same time, is sufficient to account 
for all the appearances of spasm on the ex- 
treme vessels, at the commencement, and du- 
ring the course of a simple intermittent fe- 
ver. 



59 

The arteries, which are composed of car- 
tilage and muscular fibres, have been disco- 
vered to possess a considerable portion of 
irritability or excitability, but not of sensibi- 
lity. 

When the propulsive power of the heart 
and arteries is so much diminished, in con- 
sequence of the diminished energy of the 
brain, (from whatever cause such an effect 
is produced,) that they cannot propel the 
blood with sufficient force into the extreme 
vessels, those vessels must necessarily con- 
tract, or become diminished in their diame- 
ters, and shortened in their dimensions, be- 
cause of their muscular structure, and elas- 
tic property. But in such a debilitated state 
of the heart and large arteries, those extreme 
vessels must also be affected with a corres- 
ponding state of debility, though their irrita- 
bility remains unimpaired, or may be, per- 
haps, preternaturally increased. Hence, it 
is not probable that they can give preterna- 
tural resistance to the heart and large arte- 
ries, and thereby be the indirect cause of the 
hot stage of the paroxysm in inienuitients, 
or the protraction of the febrile paroxysm 



60 

in fevers of a continued form ; both of which, 
if that were the case, would readily yield, 
as soon as the activity of the heart and large 
arteries was restored, by the employment of 
strong and diffusible stimulants. 

According to the opinion of Dr. Cullen, 
every variety of idiopathic fever depends for 
its existence, and continuance, on an impair- 
ed state of the energy of the brain, and a 
consequent spasm of the extreme vessels. 
That this theory, Dr. James Hamilton, jun. 
says, is inadequate to the explanation of the 
phenomena of typhus or continued fever, is 
presumed from the following circumstances. 

" 1st. Continued fevers are not always 
preceded by a cold fit, nor by other symp- 
toms denoting spasm of the extreme vessels ; 
and 

"%dly. The energy of the brain is not al- 
ways restored on the cessation of the fever, 
for imbecility of mind is the frequent conse- 
quence of that disease. These objections to 
the spasmodic doctrine of fever are selected 
as being incontrovertible. Others, founded 
on the inconsistency of the several parts or 



61 

principles which constitute the theory, might 
be urged." 

How the debility of the functions of the 
bratin or nervous system, according to Dr. 
Cullen's theory, proves an indirect stimulus 
to the sanguiferous system ; how this debi- 
lity acts in producing the cold stage and 
spasm of the extreme vessels ; how through 
the intervention of the debility and spasm of 
the extreme vessels, the action of the heart 
and large arteries is increased; how the en- 
ergy of the brain is restored, and how this 
energy is extended to the extreme vessels, 
is not explained by Dr. Cullen. Whatever 
rests on these points, therefore, is confessed- 
ly hypothetical, or conjectural and uncer- 
tain : and if what rests on these is excluded 
from his theory, all that remains, as is ob- 
served by Dr. A. P. Wilson, of Edinburgh^ 
will be found nothing more than a short re- 
capitulation of the symptoms of fever. 

Many other facts and arguments might be 
offered to prove that a spasm of the extreme 
vessels is not a part of the proximate cause of 
any variety of fever, but is merely a symptom 



62 

proceeding from an impaired energy of the 
sensorium, and a diminished action of the heart 
and arteries, the effect of the debilitating 
power of the remote causes; but, in my 
opinion, what has been already suggested is 
amply sufficient for that purpose. 

I shall, therefore, conclude my observa- 
tions on Dr. Cullen's theory with the repe- 
tition of an old adage, viz. "Urare est hit- 
manumy' for, though his doctrine is not per- 
fect nor free from error, it is the best that 
the state of medical knowledge, at the time 
he wrote, was calculated to admit ; and it is 
honourable even to fail in a laudable at- 
tempt. 

It appears, from a variety of passages in 
the works of the late Sir John Hunter, the 
celebrated anatomist and physiologist, that 
he considered every operation or motion of 
the human body, as an action of the vital 
principle, and that "this principle is, as it 
were, diffused through the blood, as well as 
through every solid fibre of the body, making a 
accessary constituent part thereof, and form- 
ing with them a perfect whole ; giving to both 
the power of preservation, the susceptibility 



63 

of impression, and from their construction, 
reciprocal actions, and reactions/' "It was 
also his opinion that diseases are propa- 
gated from a part, to the whole system, by 
means of the diffused vitality/' 

This author, who adopted the opinion of 
Harvey and Willis, that the blood is alive, 
founded his opinion upon the observation of 
certain phenomena, and, especially, on the 
coagulation of the blood. "This living prin- 
ciple he supposes to be the same with that 
of the rest of the body, and that something 
similar to the brain is distributed through the 
blood, w r hich he calls the diffused matter of 
life" 

It is probable this doctrine led the way to 
the doctrine subsequently taught by the noted 
Dr. John Brown, of Edinburgh, of which 
the following is an abstract. 

" Our system of solids (says Dr. Brown) 
is a form of living matter, whose characteris- 
tics are sensation and motion." 

"The susceptibility of external powers is 
excitability : the agents, stimuli or exciting 
powers : The result, excitement." "With- 
out this property, our bodies would be dead 



6* 

and inert matter ;— by this property, they be- 
come living matter — by this property, called 
into action by the exciting powers, they be- 
come living systems." "While the stimuli 
act on the excitability with a sufficient de- 
gree of power, then is the pleasant sensation 
of health : when they raise the excitement 
above this point, or depress it below it, there 
is disease. When the stimuli cease to pro- 
duce excitement, or the system to feel their 
power, there is death." 

"Excitability is a property or energy of 
living matter, peculiar and inherent; but it 
is a property which cannot be subjected to 
the cognizance of our senses, and it is to be 
referred to a point of fact. Of this energy, 
property, or principle, there is assigned a cer- 
tain portion at the commencement of life ; — 
but this quantity differs in each individual, 
and is found to change in the same subject, 
at different periods of life, and in different 
situations or circumstances; being, on the 
one hand, occasionally accumulated, abun- 
dant, or superfluous, and on the other, ex- 
hausted, deficient, impaired, or nearly extin- 
guished" 



6;? 

"The stimuli or exciting powers are heat, 
light, sound, air, and motion; the ingesta, 
the blood, the secretions, muscular contrac- 
tion — and liually, the powers of the mind; 
as perception, passion, and thought, 

"Excitement is life; the natural move- 
ments of the machine, and the functions re- 
sulting from these, are sensation, reflection, 
and voluntary motion; which, as they imme- 
diately flow from the exciting powers, are 
vigorous when these are strong; languid 
when these are weak, and cease when they 
are taken away entirely." 

Thus we are taught that the actions or 
motions of our bodies are caused by external 
agents, and that "life is a forced state;" 
that our weak frame has an unceasing ten- 
dency to dissolution, which is opposed only 
by the incessant application of exciting pow- 
ers. — That "these powers are the support 
of life, and that being partially or complete- 
ly withdrawn, are immediately followed by 
disease or death. 

"For the better understanding this doc- 
trine, it is necessary to explain this princi- 
ple, viz. " That all stimuli in acting on ex- 

F S 



66 

eitability, exhaust it; thus, the stimuli of ali- 
ment, air, motion, passion, thought, have 
supported the body through the labours 
of the day; they have supported the func- 
tions by acting on the excitability; — in the 
evening it is exhausted (or the whole sys- 
tem is weakened) by the excitability beings 
diminished by their continued operation. — 
They no longer produce the same effect; 
the functions fail ; we sink into rest, and con- 
tinue in sleep almost an equal time, unaffect- 
ed by stimuli; renewing, by sleep, that ex- 
citability which had been exhausted by the 
labours or by the exciting agents of the day. 
— We riser with restored excitability. — We 
feel a new power of excitement in every ob- 
ject around us. — We are refreshed in the 
morning, and feel languid and fatigued at 
night; and our whole life is an alternation of 
action and sleep, of apathy and pleasure; of 
wasting our excitability by day, in labour 
or enjoyment, and of recruiting it during the 
night, by sleep and the abstraction of stimu- 
lating powers." 

The same philosophy extends to the du- 
ration of life. — "In childhood excitability 



67 

is abundant in quantity, as being little ex~ 
hausted ; but it is low in power, because the 
tender stamina of that period, and accumu- 
lated excitability, can neither admit nor sup- 
port high excitement. The excitability of 
infants is so abundant, that they are easily 
supported by weak diet and low exciting 
powers. In youth, the excitability is yet en- 
tire, — the stamina are strong, — the powerful 
stimuli are applied, and high passions are 
the effect. This is the period of vigour, and 
of inflammatory disease. In old age, the 
stamina are worn and impaired, the excita- 
bility is exhausted, the common stimuli have 
lost their power, and the system begins to 
decline ; — we then have weakness of body, 
imbecility of mind, and chronic diseases, &c. 

"We may last of all, have recourse to 
more generous diet, and raise the excitement 
by substituting wine to water, or brandy to 
wine; perhaps by these means excitement 
may be a while supported, and life prolong- 
ed, but in a few years these also lose their 
effect." 

According to this doctrine, the living ac- 
tion is never produced but by exciting pow* 



68 

ers, as u there is no such thing as a direct 
sedative in nature, 

"In stimuli there is a gradation which, 
being relative to the system, deceives our 
senses; for, since some stimuli are powerful 
and others weak, a less stimulus, applied af- 
ter a more powerful one, will stimulate less 
than the former, and suffer the motions ex- 
cited by the former to subside, and will on 
that account be considered as a sedative. 

"Take heat for an example of this ; cold 
is but an abstraction of heat, yet it has hith- 
erto been thought to have a positive exis- 
tence ; and heat has been considered as a sti- 
mulant power, and cold as a sedative. To 
detect this deception of our senses, plunge 
the right hand into water at the heat of 150°, 
the left into melting snow, withdraw both, 
and plunge them into water at 100°; this 
will prove at once stimulant and sedative — 
cold or sedative to the right hand, and 
hot or stimulant to the left. — Here we clear- 
ly see that the effect is not always the same, 
but is diversified by the state of the excita- 
bility ; and as cold is an abstraction of heat, 
so is fear an abstraction of courage — grief of 



69 

joy — despair of hope — so is fasting an ab- 
straction of the usual stimulus of food — bleed- 
ing of the usual stimulus of blood, &c." 

On this part of the Brunonian theory Dr. 
Wilson remarks, that "in proportion as the 
organs on which the animal functions de- 
pend, have been subjected to the action of 
stimuli, they become less capable of being 
excited by them ; and if their application is 
continued, the strongest fail to rouse the sys- 
tem to any farther exertion, till a state of 
sleep, (during which, if it be sound, there 
is the greatest abstraction of stimuli on those 
organs,) which is consistent with health, has 
to a certain degree, renewed its excitability. 
Such are the laws of the system in health 
with regard to sleep and watching ; and the 
doctrine of indirect debility is, for the most 
part, applicable here. But these are not the 
laws of the system in disease, as supposed by 
Dr. Brown ; and his doctrines of direct and 
indirect debility are totally inapplicable to the 
other functions of the body, both in health 
and disease." 

One great error of the Brunonian theory, 
is the application of the laws which govern 



70 

particular functions or portions of the human 
system, and that only in the healthy state, to 
the system at large. This error has been 
attempted to be corrected by Dr. Rush, in 
his theory of diseases, as well as by Dr. Wil- 
son in his treatise on febrile diseases. 

Having thus stated the outline of the doc- 
trine of health ; Dr. Brown goes on to that of 
disease. 

" Health is the due operation of stimuli on 
well regulated excitability, producing a mo- 
derate excitement, and a pleasant sensation ; 
moving the whole system with a just degree 
of power, and giving to all the functions their 
due energy and action. 

"Disease of weakness is the result of the 
abstraction of stimuli, or the application of 
stimuli in too low a degree, or of the system 
less easily excited. 

ff Disease of strength is the result of sti- 
muli applied in too great a degree, or of a 
system too susceptible of excitement. 

"The first is depression below the healthy 
state : it produces languid motions of the se- 
veral functions; it is named asthenic disease^ 
or disease of weakness, corresponding with 



71 

the nervous or putrid diseases of former wri- 
ters, aud requires exciting agents for its 
cure. 

"The second is a strong system, wound 
up to a high pitch of excitement. It is an 
exhuberance of health and vigour, and is 
marked by violent movements. It is named, 
in opposition to the former, sthenic disease, 
corresponding to the phlegmasia or inflam- 
matory diseases of other writers, and is cured 
by abstracting stimuli and diminishing ex- 
citement. 

"Thus all our diseases depend upon a 
state of preternatural debility, or upon a state 
of preternatural strength, and this is the 
foundation of the scale which has health for 
its middle point; below this are arranged the 
diseases of weakness, — above it all the dis- 
eases of excessive strength, — and in both di- 
visions of the scale, diseases are so arrang- 
ed, that the worst forms are set off* at the 
greatest distance from the middle point, to 
mark them as the widest deviation from the 
healthy state. 

"But to illustrate still farther the nature 
of these two distinct forms, or classes of dis- 



ease, we must observe their respective causes. 
Sthenia, or excessive strength, or contrac- 
tile power in the muscular fibre, is simply 
the effect of many or of powerful stimuli acting 
on the system. Asthenia is the immediate 
effect of withdrawing these ; but asthenia is 
not so simple as its opposite state ; for debi- 
lity (according to this doctrine) varies in its 
nature according to its various causes. 

"1st. By abstraction of exciting powers, 
is produced a species of debility named di- 
rect. 

"%dly. By long or violent application of 
strong exciting powers, the excitability is 
exhausted ; both the excitement and strength 
of the whole system fail. This species of de- 
bility is named indirect. 

"3dly. When the exciting pow r ers are 
withdrawn, and the direct debility produced, 
it is at the same time combined with a new 
species. — By merely withdrawing the stimu- 
li, such weakness would be produced as 
should be temporary only, and might be done 
away by reapplying the usual exciting pow- 
ers; but where the stimuli are withdrawn, 
excitability is accumulated; and when it is 



73 

accumulated in an undue quantity, it cannot 
bear the usual stimuli, and will not give out 
the usual healthy excitement." 

This system turns on the hinge of direct 
and indirect debility; for direct debility, 
caused by the absence of exciting powers, is 
attended with accumulation of excitability. 
Indirect debility, caused by superabundant 
stimuli, is attended with exhausted excitabi- 
lity ; the former is most easily cured, since 
we have only to apply a due quantity of sti- 
muli, and gradually raise the excitement to 
the standard of health; the latter is more dif- 
ficultly cured, because the excitability being 
in a great degree exhausted, the system is 
less susceptible ; we have, therefore, less ex- 
citability to operate upon, for the restoration 
of excitement and consequent health. 

" The abstraction of stimuli is an imme- 
diate cause of weakness. High excitement 
is a state of the system which the excitabili- 
ty cannot long endure without being exhaust- 
ed, so that stimuli themselves produce ulti- 
mate weakness; therefore, since high ex- 
citement is temporary only, and has but one 
cause, while weakness is a permanent state, 



and has many causes, the diseases of debili- 
ty, must, in a very great proportion, exceed 
in number the diseases of excessive strength, 
and diseases of excessive strength must, ulti- 
mately, end there." 

If 97 of 100 diseases arise from weakness 
(as taught by this author) an inquiry into 
the truth of his doctrine must be of the ut- 
most importance. 

TREATMENT. 

" Though there be many individual dis- 
eases, there are but two states or different 
conditions of the system, and two methods 
of cure. For all those diseases which stand 
above the point of health, nothing more is re- 
quired than withdrawing the stimuli of food, 
drink, heat, &c. or aided by the reducing 
or debilitating evacuations and abstractions, 
such as bleeding, purging, &c. 

"For all those diseases which stand be- 
low the point of health, the natural stimuli 
of aliment, drink, heat, &c. are to be em- 
ployed; or the less natural, but more diffusi- 
ble stimuli of the pharmacopeia, the chief of 



7* 

Which are aether, alcohol, volatile alkali, 
musk, and opium, or its spirituous tincture, 
wine and alcohol. 

" The agents which cause the one form of 
disease, are the cure of the other; in the one, 
we raise the excitement till it arrives at the 
point of health; in the other, we depress it 
to the same point : having effected this, by 
the powers of medicine and regimen, we are 
to keep it there by the powers of suitable re- 
gimen, and moderate exercise, &c." The 
great object, in the practice of our author, is 
to hit the point of health : neither to stop 
short of that point nor to pass beyond it ; for 
by either practice we miss our aim. 

" By profusion of stimuli we may convert 
a disease of weakness (or of a nervous or ty- 
phus character, according to this doctrine,) 
into a disease of inflammation, or too high 
excitement, or we may carry it beyond that 
point into indirect debility. 

u By too sudden and copious an abstrac- 
tion of stimuli, we run into the opposite ex- 
treme ; converting into a disease of direct de- 
bility, what was formerly a disease of too 
high excitement, or violent inflammation. 



76 

u The use of stimuli, in asthenic disease*, 
is to he regulated by the causes. In all cases 
of indirect debility, in which the excitability 
has been exhausted, the strength must be 
raised by the immediate application of more 
powerful stimuli : after which, these are to 
be slowly reduced in quantity or strength till 
the excitability is restored, after which, mo- 
derate or ordinary stimuli will suffice to sup- 
port the excitement of health." 

" In all cases of direct debility, where ex- 
citability is accumulated, the immediate ap- 
plication of powerful stimuli would destroy 
the weakened fibres, or occasion convulsive 
motions in them ; weak stimuli must there- 
fore be first used, the superabundant excita- 
bility must be first gradually wasted, and 
the doses very slowly increased till we raise 
the excitement to the point of health." It is 
the peculiar characteristic of this doctrine, 
that it directs a method of cure, in many re- 
spects, different from that of all others. In 
proportion, therefore, as it is erroneous or 
correct, it should be estimated, and therefore 
should be refuted or confirmed. 

According to this theory, diseases consist 



14 

entirely of a state of excitement, to a certain 
extent, higher or lower than a state of health; 
for the author says " Health consists either 
in moderate excitement, or in such an ex- 
haustion of the excitability as daily occurs, 
when the sleeping state of the system is in- 
duced by the various actions and offices of 
life ; whereas, a state of too high excitement 
constitutes that form of disease which is ac- 
companied with strong action of the arterial 
sy* tern, and belongs to the class sthenia, (or 
phlegmasia ;) and too weak excitement, ac- 
companied with low, weak, or feeble action 
of the arterial system, constitutes that form 
of disease which belongs to the class asthe- 
nia, or preternatural debility." 

The indications of cure, we are told, are 
to be formed and prosecuted according as 
the nature of the one or the other form of the 
disease is indicated by the remote causes to 
which the patient has been subjected ; and 
not according to the indications of the symp- 
toms, which this author considers fallacious, 
and apt to mislead ; and according to this 
hopeful opinion, which might be suspected 
to have been fabricated in an hospital of lu« 



g 3 



78 

natics, the excitability, which is only a dif- 
ferent name for the vital principle, becomes 
accumulated in quantity in proportion to the 
privation or abstraction of customary stimuli, 
by which the due ratio or relation between 
it and the healthy excitement had been main- 
tained, and that, as the powers which sup- 
port life are diminished, life itself, or the 
principle on which the phenomena of life de- 
pend, is increased. 

But the fact is, that excitability and ex- 
citement, instead of being in an inverse ratio 
to each other, as supposed by Dr. Brown, 
are observed to decline in an equal propor- 
tion through all the different stages and de- 
grees of every disease whose symptoms indi- 
cate great debility in the principal functions 
of the human body; this is particularly evi- 
dent in cases of typhus gravior, cyanche ma- 
ligna, &c. According to this doctrine also, 
by the abstraction of customary stimuli aid- 
ed by the evacuating remedies, in cases of 
exhausted excitability, from the application 
of too strong and too many stimuli, direct de- 
bility is said to be superadded to indirect 
debility; this opinion, however plausible it 



79 

may appear, is contradicted by numerous 
facts. 

If the usual refreshing drinks and aliment 
are withheld from a patient in an advanced 
stage of malignant fever, or gangrenous sore 
throat, and only cold water is given, no ac- 
cumulation of excitability or susceptibility to 
action will take place; but, on the contrary, 
the exhaustion and torpor will rapidly pro- 
ceed, unless counteracted by suitable exciting 
agents. 

If a person, previously exhausted by fa- 
tiguing exercise and exposure to the heat of 
the sun, drinks a large quantity of cold wa- 
ter, or plunges suddenly into a cold bath, 
the excitability will not be increased, and 
the sense of exhaustion thereby removed, 
but, on the contrary, those greater degrees 
of exhaustion will be induced which dispose 
to spasm of the stomach, convulsions of the 
muscles, or to tetanus, &c. 

The doctrine of excitability increasing in 
the whole or some particular poruon of the 
system, in consequence of the abstraction of 
customary stimuli, appears to be not only 
exceedingly hypothetical, but is contradicted 



80 

by facts familiar to every observing physi- 
cian. — In the last stage of typhus fever, for 
instance, when debility is hourly increasing, 
instead of the excitability becoming more 
abundant, (which can only be ascertained by 
the greater or less motion of the living fibres, 
observable upon the application of stimuli,) 
the patient is very frequently observed to be 
insensible to the impression of the most pow- 
erful stimuli; and sometimes so insensible, 
that flies may crawl over that tender organ 
the eye, without creating any uneasiness. 
But the circumstances attending the varie- 
ties of the sthenic or inflammatory class of 
diseases, entirely refute this doctrine.— in 
these, the author supposes that the excite- 
ment is increased, and the excitability di- 
minished, in consequence of the operation of 
too powerful stimulating agents. If, how- 
ever, the state or quantity of excitability is 
to be measured by the degree of susceptibi- 
lity to the action of stimuli, who, after a mo- 
ments reflection, will have the folly to say, 
that in such cases, the excitability is dimi- 
nished, when the system, or that part of it 
which is the seat of disease, is afl'ecied by 



81 

such stimuli as would not be felt in a state 
of health. 

According to the theory of this eccentric 
teacher, every variety of the sthenic class 
depends upon a state of excitement to a cer- 
tain extent above the standard point of health, 
which he has attempted to exemplify by an 
imaginary scale, and every variety of the as- 
thenic class depends upon a certain defect 
of excitement below the same ; and he teaches 
that the indications of cure are to be derived 
from these opposite states of excitement. 

In refutation of his doctrine of life, it may 
be observed, that the actions which are pro- 
duced in the living body by the operation of 
stimulating agents, are not the cause of life, 
as asserted, but merely the phenomena and 
effect of life, or of the action of appropriate 
stimuli upon the principle of life. — Life may 
and does exist, without organic action ; but 
organic action in the living body cannot be 
produced without the presence of the vital 
principle, or excitability. — Life is the pri- 
mary or efficient cause, of which organiza- 
tion is the secondary or instrumental cause; 
and organic action itself, is the proximate 



82 

effect, which proceeds from the impression 
made by exciting agents upon the living prin- 
ciple seated in the animal solids. 

So long as the relation continues to sub- 
sist between the excitability or susceptibility 
of the system to be acted upon, and the pow- 
ers of the agents applied, it receives the sup- 
ply that it constantly requires, and the agree- 
able sensation of health, is the effect. 

If life was the forced state that Dr. Brown 
and his followers suppose it to be, the ap- 
plication of stimulating substances or excit- 
ing agents, duly proportioned to the existing 
state of excitability, would preserve mankind 
in perpetual health, and render them immor- 
tal; for, instead of being forced to die, they 
would be forced to live // 

If the principles of his doctrine, relative 
to the proximate cause of disease, were cor- 
rect and true, no disease by which the whole 
system is affected would be incurable; for, 
if disease depends only upon weakness or 
strength of the living system, and weakness 
and strength depend upon different degrees 
of excitement above or below the standard 
point of health, and nothing is to be ascribed 



83 

to the fault of the solids or fluids; so long 
as excitability remains, so long as the sys- 
tem lives, and so long as we have at com- 
mand stimuli of all degrees of power, dis- 
cernment and judgment in their application 
would be all that would be necessary to re- 
store the disordered system to a healthy 
state. 

Like the fanciful and enthusiastic Van- 
helmont, Dr. Brown unfortunately imagined 
that genius could supply the place of expe- 
rience and observation, and rejecting with 
disdain the facts which had been collected 
by his predecessors, he rashly formed plans 
of treatment which, if adopted, would in 
many cases prove fatal, and particularly in 
apoplexy, and dysentery, and in thfc first 
stage of phthisis pulmonalis, &c. 

If disease depends only on excitement to 
a certain extent above or below the healthy 
point, and if excitement last no longer than 
its cause, how comes there to be any perma- 
nent disease? 

If a man in health, drinks wine to excess 
one day, and none the next, the excitement 
immediately subsides and he feels debili- 



84 

tated. This is not the case in disease. If 
perineumony be produced by the excessive 
stimulus of heat, after previous exposure to 
cold, as his doctrine supposes, why is it not 
removed by abstracting that stimulus and 
exposing the patient to freezing air, or im- 
mersing him in a bath of cold water, which 
is said to operate only by abstracting excess 
of animal heat? 

Another circumstance which shews the in- 
correctness of the Brunonian doctrine, is, the 
effect produced by different articles of the 
materia medica, all of which are pronounced 
by our author to operate only by a stimulat- 
ing power. 

If all the powers which produce action in 
the animal machine operated only as stimu- 
lants, they must all have one common na- 
ture or quality, and differ only in the degree 
of power. But there can be no doubt that 
individual stimuli differ widely from each 
other in their nature and mode of action; 
some produce hilarity, as wine and opium ; 
one produces phrenzy, as the seeds of the 
belladona, or deadly night shade ; a second, 
colic, as the acetate of lead ; a third, tempo- 



85 

rary mania, as the seinina stramouii ; a fourth, 
cholera and convulsions, as arsenic and sub- 
muriate of mercury; and a fifth, strangury, 
as cantharides, &c. From this it appears that 
stimuli differ in quality as well as in degree of 
power; for if they differ in degree only, then 
might the first stimulus in a more concen- 
trated form have produced the same effect; 
of course, nosology must be something more 
than a mechanical scale, and our pharmaco- 
peia, something more than a rising series of 
stimulant powers; otherwise, opium, aether, 
and alcohol, as strongest stimulants, could 
by dilution give out all the lower degrees of 
stimulant power, and -every variety of dis- 
ease of the asthenic class, should recede be- 
fore its appropriate degree. 

But if ipecacuanha operates upon the sto- 
mach, jalap and rhubarb on the intestines — 
If nitre affects the kidneys, cantharides the 
bladder, and mercury the salivary glands, 
they must have some peculiar quality super- 
added to their stimulant power, and their 
stimulant power must be only a subordinate 
effect. Tf they are stimuli, they are such as 

H 



86 

operate only on certain parts of the system, 
while they have no effect upon others. 

If bark cure an intermittent, or mercury the 
syphilis, which neither opium, aether, nor 
brandy can do, then it ought to be the chief 
study of the physical! to discover these spe- 
cific and peculiar powers. 

If all stimulants were the same in kind, 
and only differed in degree, or were uniform 
in their action, water, heated to a certain de- 
gree, would intoxicate, as well as wine or 
alcohol. 

Many other facts and arguments might be 
offered to prove the imperfection, inconsis- 
tencies, and errors of the Brunonian system 
of physic, and the pernicious tendency of the 
practice which it inculcates, especially in 
diseases of a mixed character, such as ver- 
nal intermittents, dysenteries, apoplexies, 
&c. ; but as these must be obvious to every 
person of common discernment, that is ac- 
quainted with the animal economy and the 
rules of inductive philosophy, it would be su- 
perfluous to add any thing farther on the sub- 
ject, in proof of the doctrine of this ingenious 
teacher being glaringly erroneous in its prin- 



87 

eiples, inconsistent with the laws of the ani- 
mal economy, and dangerous in its applica- 
tion to practice. I shall, therefore, proceed 
to the consideration of the Theory or Doc- 
trine of Diseases, published by the late Dr, 
Erasmus Darwin, author of the elegant 
poem called "The Botanic Garden." 

According to the theory of this ingenious 
writer, the sensorium possesses four distinct 
powers or faculties, which are occasionally 
exerted, and produce all the motions of the 
fibrous parts of the living body. — These are 

ist. The faculty of producing fibrous mo- 
tions, in consequence of irritation, excited by 
external substances. 

2d. The faculty of producing fibrous mo- 
tions, in consequence of sensation, which is 
excited by pleasure or pain. 

3d. The faculty of producing fibrous mo- 
tions, in consequence of volition, which is 
excited by desire or aversion. 

4th. The faculty of producing fibrous mo- 
tions, in consequence of association, • which 
is excited by other fibrous motions. 

The author considers the exuberance, 
deficiency, or retrograde action of these fa- 



88 

eulties of the sensorium, as the proximate 
cause of every individual disease; and, ac- 
cording to this view of the subject, he has 
divided all diseases into four classes, accord- 
ing as they depend upon the disordered state 
of one or other of the above mentioned facul- 
ties. 

These four classes are divided into distinct 
orders, genera, and species. 

The orders of the different classes are 
named from the excess, deficiency, or retro- 
grade action of the proximate causes. The 
genus from the proximate effect; and the spe- 
cies, in general, from the locality or situa- 
tion of the disease in the system. 

The superior advantage of classing dis- 
eases according to their proximate causes, 
in the opinion of Dr. Darwin, is, 1st. more 
distinctly to understand their nature by com- 
paring their essential properties. 2dly. To 
facilitate the knowledge of the methods of 
cure; since, in the natural classification of 
diseases, the species of each genus, and in- 
deed the genera of each order, with perhaps 
a few exceptions, require the same geLtjral 
method of treatment; and lastly, to discover 



89 

the affinity of a disease not previously known, 
by comparing it with those with which the 
physician is already acquainted. 

Dr. Darwin supposes that the faculties of 
the sensorium depend upon the presence of a 
subtile elastic fluid secreted by the brain, 
which he denominates "sensorial power," 
or the spirit of animation. 

In the first volume, page 6th. of his Zoo- 
nomia, he says "the similarity of the tex- 
ture of the brain to that of the pancreas and 
some other glands of the body, has induced 
the inquirers into this subject to believe, that 
a fluid, perhaps much more subtile than the 
electric aura, is separated from the blood by 
that organ for the purposes of motion and 
sensation. 

"When we recollect (adds this ingenious 
author) that the electric fluid itself is ac- 
tually accumulated and given out volun- 
tarily by the torpedo, am! the gymnutus elec- 
trials, that an electric shock vvih frequent- 
ly stimulate into motion a paralytic limb, and 
lastly, that it needs no perceptible tubes to 
convey it, this opinion seems to be not with- 
out probability; and the figure of the brain 

h 3 



90 

and nerves seem well adapted to distribute 
it over every part of the body. 

"All bodies possessing life and motion 
have a peculiar organization,' and the muscu- 
lar parts possess a principle of excitability, 
or a capacity of contracting and shortening 
their fibres, in consequence of impressions 
made on them by external agents." 

The section on stimulus and exertion, in 
Dr. Darwin's Zoonomia, contains the prin- 
ciples which constitute the ground work of 
his theory; of which the following is a brief 
abstract, 

"1st. There is diffused throughout the 
animal system, a certain property which 
may be denominated sensorial jjower, or the 
principle of animation.* 

"2d. When stimulating substances are 
applied to the body they produce motion in 
the muscular fibres by their action upon this 
sensorial power or principle of animation." 
These produce a certain effect which he calls 
exertion, and which by others is called con- 
traction. 

* This is what Dr. Brown calls " excitability.*' 



9i 

"3d. If the stimulus be greater than cus- 
tomary, it exhausts the sensorial power; but 
if the stimulus applied be less than the sys- 
tem has been accustomed to, the sensorial 
power becomes accumulated and superfluous. 

"4th. The exertion (or contraction of the 
fibres) is varied ; first, by the quantity of 
sensorial power, secondly, by the quantity 
or forcible impression made by the stimulus, 
and thirdly, by the proportion which these 
bear to each other. 

"5th. If the sensorial power and the sti- 
muli are in due proportion to each other, and 
neither have gone to excess, or fallen too 
low, the exertion and excitement produced, 
is moderate and regular, and constitutes 
health. 

"6th. When the exertion is too strong, 
and the excitement too high, either from an 
excess of stimulus, from an excess of the 
presence of sensorial power, or from an in- 
crease of both, it constitutes disease : and 

"7th. When the exertion (or excitement) 
is much diminished, either from a deficiency 
of stimulus, or from deficiency of sensorial 
power, or from a deficiency of both, it also 



92 

constitutes disease, but of a different charac 
ter from the former : 

"The diseases of the former kind, re- 
quiring depleting and debilitating remedies, 
and those of the latter, stimulating and invi- 
gorating ones." 

From this brief abstract it appears that 
the theory of Dr. Darwin and that of Dr. 
Brown, bear a striking resemblance to each 
other in several particulars ; they, however, 
differ materially from each other in several 
other respects. 

They agree in the doctrine that the ap- 
plication of stimuli will increase exertion or 
excitement, and that the abstraction of sti- 
muli will diminish it : they agree in suppos- 
ing that the exertion or excitement, simply 
varied in degree above or below the usual 
scale of health in each individual, consti- 
tutes disease; and that it constitutes health, 
when at a medium. They also agree in the 
supposition that a diminution of action, from 
the abstraction of stimuli, is accompanied or 
followed by an increase of sensorial power 
or excitability. 

But though they both agree with respect 



93 

to the existence of excitability or sensorial 
power, Dr. Brown does not pretend to know 
from what source it is .derived, or how it 
originates; whereas, Dr. Darwin considers 
it to be a subtile fluid secreted by the brain, 
and from thence distributed to every part of 
the living system. 

They disagree with respect to the nature 
of stimuli; Brown supposing them all to be 
of the same nature, varying only in their de- 
gree of power; while Darwin contends that 
they are different in their nature, some being 
particularly adapted to act on one part of the 
body, and some on another ; thus " antimo- 
nium tartarasatum, taken into the mouth, 
produces little or no irritation, but when 
swallowed produces so great an irritation in 
the stomach, as to invert its motion and oc- 
casion vomiting :" again, ipecacuanha acts 
upon the stomach, mercury on the salivary 
glands, squills on the kidneys, and cantha- 
rides on the bladder, and jalap, senna, sul- 
phate of soda, &c. upon the intestines, &c. 

Dr. Brown supposed that an increase of 
either excitability or of stimuli so as to pro- 
duce an increase of excitement, would pro- 



duce an increase of strength ; whereas, Dr. 
Darwin asserts that, to produce strength, it 
is necessary that the quantity of sensorial 
power and force of the stimulus should both 
be increased. 

As the theory of Dr. Darwin agrees with 
that of his cotemporary Dr. Brown, in mak- 
ing disease to consist only in different de- 
grees of excitement above or below the stan- 
dard of health, the objections which have 
been urged against the most material part of 
Brown's, will apply with equal force to the 
most material part of Dr. Darwin's theory. 

Though Dr. Darwin considers stimuli to 
differ in their nature and properties from one 
another, he supposes, with Brown, that there 
is no direct sedative or article of the materia 
medica that produces sedative effects in the 
first instance, but that all such phenomena 
are the effects of evacuation, depletion, or 
abstraction of stimulant agents. The follow- 
ing facts, however, shew this opinion to be 
erroneous. 

u The depressing passions immediately oc- 
casion a sense of debility in the vital and na- 
tural, as well, as in the animal functions. 



95 

The effects of fear or grief upon the human 
body, arising to any considerable degree, are 
loss of appetite, indigestion, and other symp- 
toms of dyspepsia ; and that degree of debi- 
lity which produces the morbid watchful 
state. The system also under the operation 
of the depressing passions, becomes more 
susceptible of deleterious power, as the mi- 
asmata of marshes, the contagion of typhus, 
&c. 

u The same total derangement of the orga- 
nization, follows the excessive operation of 
these passions, as well as of those of the ex- 
citing kind. 

" It has been alledged that the depressing 
passions are only a diminution or abstraction 
of the exciting passions, not the emotions of 
an opposite nature, and that they are there- 
fore to be considered as weak stimuli, and 
that their operation upon the body is the 
same as the abstraction of the necessary sti- 
muli. 

"This opinion is glaringly incorrect; first, 
because no power can be considered as sti- 
mulant, unless when operating in a certain 
degree, it has the effect of increasing action 



96 

in the moving powers of the system. But 
fear or grief, operating in any degree, pro- 
duces debility. 

"%Aly. It is manifestly absurd, to suppose 
that grief is merely the abstraction of joy, or 
fear of courage. We cannot avoid perceiv- 
ing, that the depressing passions are not 
mere abstractions of stimulating agents, but 
are rather powers, which operate with consi- 
derable force, inducing direct debility in the 
system. This class of passions must, there- 
fore, be considered as sedative powers ; and 
the conviction that they are such, naturally 
leads us to conclude, that there are other 
substances in nature, which also produce a 
directly sedative effect upon the body. Such 
appear to be marsh miasmata, and the con- 
tagion of typhus fever." See Herdman on 
Animal life. 

If the gas called carbonated hydrogen, or 
hydro-carbon, which consists of a mixture of 
carbonic acid gas and hydrogen gas, or of 
fixed and inflammable air, be inspired in an 
undiluted state, it is followed by instant 
death; and when inspired in a small quanti- 



97 

vy only, mixed with atmospheric air, or with 
oxygen gas, and be continued for any length 
of time, it induces vertigo, dimness of sight, 
convulsions, aud every symptom of approach- 
ing death. Its noxious effects are therefore 
referable to its action on the nervous system, 
upon ivhich it produces directly sedative ef- 
fects. From this circumstance, Dr. Bostie 
observes that "the doctrine of there being no 
direct sedative power in existence, is one of 
the most singular contests of theory against 
experience in modern times." Essay on lie- 
spiration. 

If the principles of the doctrine taught by 
Dr. Darwin were true, it would be next to 
impossible for any person to be deprived of 
life, by exposure to freezing air in the most 
dreary climates of the globe, unless there was 
a total abstraction oi heat from the atmos- 
phere; for, though. the cold be continued in 
the same degree, its effects must gradually 
decrease, from the accumulation of the sen- 
sorial power, till at length its influence on 
the body would be the same as when the sti- 
mulus of heat was greater, and the sensorial 
power less. 



98 

The theory or explanation of the pheno- 
mena of fevers, proposed by Dr. Darwin, is 
chiefly founded on a sympathy or association 
of parts; in consequence of which, it has ob- 
tained the title of "the sympathetic theory of 
fever." 

Direct sympathy is used by Dr. Darwin, 
to express an increase or decrease of motion 
in the secondary or associate fibres, corres- 
ponding with the increased or decreased mo- 
tion of the fibres of the part originally affect- 
ed. Bat it is impossible that the same mov- 
ing fibres should be excited at one time by 
direct, and at another by reverse sympathy, 
or that the same cause should at one time 
increase their action, and at another dimi- 
nish if. 

If Dr. Darwin's physiology was correct, no 
inequality could continue for any length of 
time, between the excitability of different or- 
gans or functions of the body; for, if the 
sensorial power be a fluid, as asserted by Dr. 
Darwin, and becomes accumulated more or 
less rapidly, during the existence of a state 
Of torpor, quiescence, or inaction, produced 
In consequence of too violent stimuli having 



09 

previously acted on the same, it would over- 
flow; agreeably to the laws by which other 
fluids are governed, into every part, till all 
were on a level, and then every part would 
be liable to the same or a proportionable de- 
gree of action. 

If in the intermittent fever, the stomach is 
primarily affected as this author teaches, the 
diminution of action in the heart and arte- 
ries, during the cold stage, cannot be the ne- 
cessary result of associate motions, or sympa- 
thy with the stomach; otherwise, the slight- 
est degree of indigestion would always bo 
attended with similar symptoms. 

In accounting for the accession of the hot 
fit, our author observes, that "the sensorial 
power, which would have been expended 
in the primary fibres in the mode of irrita- 
tion, and in the secondary fibres in the mode 
of association, being accumulated during the 
cold fit, the arterial system is excited to vio- 
lent action, in consequence of this accumu- 
lation, by the agents, which are always more 
or less in operation so long as life exists. " 

If the organ or part primarily affected, 
during the cold fit of fever, be excited by it* 



100 

accustomed stimulus, and act with less ener- 
gy, from previous exhaustion of sensorial 
power, it will, by gradual accumulation, re- 
gain its natural quantity, and the organ being 
then in the same state as before the exhaus- 
tion, and the stimulus of the same force, the 
subsequent violent action cannot be explain- 
ed on the principles of this doctrine. 

If the quiescent or torpid organ, supposed 
by this doctrine to be primarily affected, was 
suddenly supplied with a quantity of senso- 
rial power, it might be supposed, after con- 
tinuing torpid or quiescent a certain time, to 
glow with unnatural violence ; but if during 
torpor or the cold stage, the sensorial power 
is gradually accumulated, and less stimulus 
be applied than usual, the torpor must gra- 
dually cease, till at length the body will be 
affected in the same manner as during its 
healthy state, as the sensorial power or spirit 
of animation, will have accumulated in a 
proportion equal to the defect of the stimu- 
lus : but this cannot be the case, as the sup- 
ply supposed to be secreted by, and derived 
from the brain, cannot have increased during 
the cold stage, because of the torpor which 



101 

precedes and accompanies that state of the 
system; there must, therefore, be some other 
cause for the accession of the iiot fit. 

During the cold or forming stage of fever, 
there is a suspension of the circulation in the 
extreme or minute branches of the capillary 
arteries in every part of the body. To ac- 
count for this state of the vessels, is the great 
desideratum in theory; but, neither this, nor 
the accession of the subsequent hot fit, can 
be accounted for in a satisfactory manner on 
the principles of either the Cullenian, the 
Brunonian, or the Darwinian theory. 

In the production of fever, whether the 
remote cause be marsh miasmata or human ef . 
fluvia, Dr. Darwin is of opinion that it makes 
its first impression upon the stomach; the 
sensorial power, in the muscular fibres of 
which it expends by the high excitement pro- 
duced thereby, and that from thence a simi- 
lar torpor or quiescence is propagated by 
direct sympathy or association of action, to 
the rest of the system : In other words, he 
considers the remote cause of every species 
of fever, to be a powerful stimulus; the con- 
sequence of the action of which, is indirect 

\2 



102 

debility, from the expenditure of sensorial 
power. 

In every variety of fever, Dr. Darwin ap- 
pears to suppose that the remote cause, gra- 
dually expends the sensorial power in the 
muscular fibres of the stomach, till, by the 
intervention of the cold stage, a fresh supply 
Is generated and accumulated in all the mov- 
ing fibres of the system, in consequence of 
which, the susceptibility to stimuli becomes 
so great that a febrile commotion is excited 
by stimulants of so low a degree as, in a 
state of health, would produce no perceiva- 
ble effect. But from all the symptoms which 
precede and accompany different kinds of 
fever, it may be concluded with probability 
nearly equal to certainty, that the remote 
causes of fever do not operate in the first in- 
stance upon the stomach, and from thence, 
by associate motions, bring the rest of the 
system into a similar condition; on the con- 
trary, all the phenomena indicate that tlie re- 
mote causes of fever are introduced into the 
circulation through the medium of respira- 
tion, and thereby carried, by means of the 
blood, to every part of the system to which 



103 

they extend. From the most accurate aud 
impartial inquiry, it appears convincingly 
clear that not the stomach, but those parts 
which are open to the air in its passage to 
the lungs, and the lungs themselves are the 
only parts which can be considered as alto- 
gether, and at all times assailable by the 
noxious matters mixed with, or floating in 
the atmosphere; and that it is by the system 
of absorbents that they find a ready passage 
to the blood, and by it, to the system gene- 
rally ; and from the symptoms which usually 
are the consequence of the reception of marsh 
miasmata into the circulating fluids, it may 
be inferred that they produce a proportiona- 
tely greater morbid effect in the nervous than 
in the arterial portion of the system ; where- 
as, the exhalations from the living human 
body, labouring under that form of fever call- 
ed typhus, produce a greater degree of mor- 
bid affection in both portions of the system. 
If marsh miasmata, the most usual cause 
of intermittent fever, produced disorder by a 
stimulating property, their effects would be 
instantly perceived, like those of other sti- 
mulating substances: and instead of a cold 



104 

stage, they would necessarily produce the 
symptoms of the hot stage in the first in- 
stance, and the cold stage could only occur 
after the febrile commotion or increased ac- 
tion, produced by the miasmata, had exhaust- 
ed the excitability to a certain degree, and 
thereby induced a sense of debility and tor- 
por of the nervous and muscular parts of the 
system. 

The opinion, that the stomach is the pri- 
mary seat of fever, is rendered highly hypo- 
thetical and improbable by numerous facts. 
Dr. Cullen, who from his accurate and lumi- 
nous description of diseases merits the grati- 
tude of the medical world, states that upon 
the approach of the paroxysm of fever, " the 
patient is affected first with languor or a 
sense of debility, a sluggishness in motion 
and some uneasiness in exerting it, with fre- 
quent yawning and stretching. At the same 
time the face and extremities become pale 
and diminished in size, and the skin over the 
whole body, appears constricted and rough, 
as if cold water had been suddenly applied 
to it. At the accession of these symptoms, 
some coldness of the extremities, though lit- 



105 

tie noticed by the patient, may be perceived 
by others. At length the patient himself is 
sensible of cold, first in his back, and from 
thence, passing over the whole body. This 
sense of cold, or chilliness, is what consti- 
tutes the beginning of the cold stage; upon 
the approach of which, the appetite for food 
ceases, and does not return till the paroxysm 
be over, or a sweat has Sowed fur some time. 
As the cold stage advances, there frequently 
comes on a nausea or sickness, which often 
increases to a vomiting of matter that is, in 
cases of intermittent fever, for the most part 
bilious." 

Here the dependent condition of the sto- 
mach upon the primary moving powers of the 
system, is plainly to be discerned. The 
sense of debility, the paleness and shrinking 
of the face and of the whole surface of the 
body, the sensation of cold, to which may be 
added, the smallness and weakness of the 
pulse, occurring on the first perception of the 
debility, all shew, that the sensorium or 
source of the nervous system, is primarily 
disordered by the cause of the fever, while, 
at the same time, the state of the stomach is 



106 

but little altered, till all these phenomena 
have taken place. From all these circum- 
stances, it appears that the disordered state 
of the stomach is, unquestionably, of a secon- 
dary or symptomatic nature. 

Upon this ground, Dr. Darwin's opinion 
that that form or description of fever, with 
weak and frequent pulse and great prostra- 
tion of strength, (denominated typhus mitior 
or gravior, according as the symptoms are ac- 
companied with more or less debility or sud- 
den and continued prostration of strength,) 
is the effect of torpor, or a state of inactivity 
produced in the stomach by the contagious 
principle, which gives origin to this disease, 
expending by its stimulus, the sensorial pow- 
er or excitability of the muscular fi§res of 
the stomach, must appear to be mere conjec- 
ture, unsupported by facts or correct obser- 
vation. 

If, on the other hand, the sensorial power 
becomes accumulated, as supposed by Dr. 
Darwin, in consequence of the inaction of 
the fibres of a particular part of the system, 
and in consequence of the abstraction of cus- 
tomary stimulus, the most indolent and inac- 



107 

tive should be most capable of bard labour 
and extraordinary exertion; and, instead of 
being subject to diseases of an asthenic or 
nervous character, or those in which debili- 
ty of the nervous system is the most predo- 
minant symptom, on this hypothesis, as well 
as on that of the late Dr. Brown, should be 
liable to continual attacks of inflammatory 
diseases; because, during the inaction of the 
fibres of any particular organ, or of the ca- 
pillary vessels on the internal or external 
surface of the body, the sensorial power or 
excitability would accumulate to so great a 
degree as to render the application of the 
usual stimuli insupportable. 

On a subject so abstruse, as well as. on 
those that are involved in less difficulty, we 
are authorised, by the rules of genuine phi- 
losophy, to reason only from unequivocal 
facts and the most correct observations. 

From the most careful and impartial in- 
quiry, it appears convincingly clear, that not 
the stomach, but those parts which are open 
to the air in its passage to the lungs, and the 
lungs themselves, are the only parts which 
^an be considered as altogether and at all 



108 

times assailable by the. remote or occasional 
causes of fever; the most usual of which, are 
noxious matters floating in the atmosphere; 
and that it is by the system of the pulmona- 
ry absorbents, that they find a direct pas- 
sage to the blood, and through it, to the sys- 
tem generally, and by that means, produce a 
change in the power of the nervous system, 
and in the excitability or vital principle ex- 
isting in the heart and arteries, as well as in 
the involuntary muscles. 

It would be unreasonable to suppose that 
marsh miasmata, or the volatile substances 
derived from putrefying vegetable and ani- 
mal substances, when received into the hu- 
man system, act as strong and direct stimu- 
lants, producing indirect debility by expend- 
ing sensorial power or excitability, when we 
gee them so manifestly aided, in the produc- 
tion of fever, by the abstraction of such sti- 
muli as the patient has been accustomed to; 
and, particularly, by cold, hunger, fear, and 
depleting remedies. The previously stimu- 
lating power of this cause has never been 
perceived by the patient on whom it ope- 
rates, and the very slow progress of the ear- 






109 

ly symptoms, which is so frequently observ- 
able, is a strong argument against the fact, 
and against the validity of this doctrine. 
Nor can the contagion of the jail or hospital 
fever be a stimulating substance, wasting ex- 
citability, and inducing indirect debility, be- 
cause its effects are favoured, and it is ren- 
dered more certain in producing fever by se- 
datives, such as hunger, cold, fear, grief, 
and depleting remedies ; and because its ef- 
fects are frequently counteracted by stimu- 
lating and invigorating means, applied soon 
after exposure to contagion. Febrile conta- 
gion has less influence over the robust con- 
stitution, than over one that is weak and in- 
firm. It generally operates slowly, and the 
patient feels indisposition for some days be- 
fore the fever makes its attack. 

The most constant phenomena of the in- 
termittent fever, indicate that its source and 
principal seat is in the nervous system, and 
particularly in that portion of the sensorium 
concerned in voluntary motion, or in the 
fibres of those muscles which in a state of 
health, are obedient to the will. This,. like 
the effects of digitalis, is more distinctly in- 

K 



110 

dicated at the accession, or during the cold 
stage of intermittent fever; in which case, in- 
stead of its cause acting immediately upon the 
heart and arteries, and increasing their force 
and fulness, it acts primarily upon the brain; 
in consequence of which, all the other func- 
tions and organs of the body, at first, exhibit 
a corresponding diminution of power and 
force of action ; but such is the structure and 
nature of the animal economy, that the heart 
and arteries soon react upon the confined 
and distending fluids, in consequence of the 
stimulus of distension, from the accumulat- 
ing blood, which being pressed from the 
extremities through the veins towards the 
heart, gradually displaces that which was 
before stagnant in its right cavities, which 
entering the pulmonary system in. its turn, 
pushes forward successively into the left ca- 
vities ; first, that which occupied the pulmo- 
nary veins, and afterwards, that which had 
undergone the proper changes in the air 
cells; when this reaches the left cavities, it 
stimulates them to action, which at first is 
feeble, but which, when the excitability is 
not materially impaired, gradually becomes 



Ill 

stronger. If the reaction or contraction, in 
consequence of this distension, aided by the 
additional stimulus of caloric received from 
the air by means of respiration, becomes suf- 
ficiently strong to restore energy to the brain 
and due harmony between the different func- 
tions, health is the consequence; but when 
the reaction is either too weak or too violent, 
the feverish paroxysm will continue until 
such time as an equilibrium, or unison of ac- 
tion, is restored between the different por- 
tions of the system. 

If the torpid and diminished power of the 
sensorium, or the proximate cause of the cold 
stage, should be so far removed by the sub- 
sequent reaction of the heart and arteries, 
that the several functions are restored to 
due harmony of action, the fever passes -oft, 
to return no more. 

But on the other hand, when the reaction 
has been deficient, the fever will only remit, 
and when it has been so violent as to bring 
on indirect debility, the blood ceases to sti- 
mulate the heart sufficiently to produce suffi- 
cient unison of action in the several func- 
tions: hence debility gradually increases, aud 



113 

after a certain period, langour and a sense 
of cold returns,-' followed by the same train 
of symptoms as at first 

In this manlier the paroxysms will con- 
tinue to return, either at regular or irregular 
periods, according to a number of adventi- 
tious circumstances, until, by the constitu- 
tional powers of the animal economy or the 
assistance of art, a reciprocal harmony and 
unison of action are established between the 
different functions. 

To conclude: If there was no other ob- 
jection to the doctrine of this ingenious and 
respectable author, the complexity and intri- 
cacy in which Ills principles are involved, 
would be sufficient to render its correctness 
and validity questionable; because intricacy 
is contrary to the usual simplicity of nature, 
and because of the difficulty of applying it 
to any practical use : I shall, therefore, de- 
cline anv farther consideration of it for the 
present, and refer the reader for a more am- 
ple analysis and refutation of it to a work, 
entitled '¥ Observations on the Zoonomia, by 
Thomas Brown, Esq. of Edinburgh," pub- 
lished in the year 1798, and to the 24th. vol. 



113 

of the Critical Review, published the same 
year. 

In a 'reatise on Febrile Diseases, lately 
published by Dk. Alexander Philips Wil- 
son, of Edinburgh, he considers the proxi- 
mate cause of fever to be '* a change in the 
laws of excitability." 

"We know (says this author) that the 
laws of excitability, in fevers, are different 
from those which prevail in health ; because 
the same external agents, the same degree of 
exercise, the same degree of temperature, the 
same quantity of food, of light, of sound, &e, 
which in health, occasion regular and agree- 
able excitement followed by gradual exhaus- 
tion, in fever, produce excessive excitement, 
followed by increased action. 

"The state of the living solids being thus 
changed, there must be a corresponding 
change in the effects of the internal agents, 
the circulating and other fluids; hence pro- 
ceed the phenomena of fever. 

* The proximate cause of fever may, there- 
fore, be concluded to be a change in the 
laws of excitability ; in consequence of which, 

K 2 



• 114 

the same agents no longer produce the same 
effects. 

" When a state either of excessive excite- 
ment, or of atony, exists independently of 
the application of some artificial agent, one 
of two changes must, have taken place ; either 
the quantity, or the quality of the natural 
agents, or the state of the living solid, is dif- 
ferent from that which prevails in health. 

"If it can be shewn that the state of the liv- 
ing solid remains the same, it follows that 
the deviation from health is owing to some 
change in the natural agents. 

"If it can be proved that the state of these 
agents remains the same, it then follows, that 
the deviation from health, is owing to some 
change in the state of the living solids. We 
may go a step farther : If it can be proved 
that the state of the natural agents remains 
unchanged and yet produce effects different 
from those they produce in health, it not 
only follows that the state of the living solid 
is changed, but also, that if the change in the 
state of the living solid will account for the 
changes observed in the effects of other na- 
tural agents, we are not in any degree to at- 



lis 

tribute such effects to a supposed change m 
those agents, there being no occasion for any 
such hypothesis to explain the phenomena. 
In fevers, many of the natural agents, calo- 
ric, food, light, and noise, for example, evi- 
dently remain unchanged ; the difference in 
their effects, therefore, is owing to the change 
in the state of the living solid. But this 
change in the state of the living solid, is ca- 
pable of accounting for the change we ob- 
serve in the effects of those agents whose 
conditions we cannot with precision ascer- 
tain — as the circulating and other fluids : It 
follows, therefore, that whatever change may- 
take place in these, during the progress of 
fever, and however this change may modify 
the symptoms of fever, it would be illogical 
to consider too great lentor, acrimony, or 
other morbid condition of the fluids, as the 
proximate cause of fever. 

" With respect to the hypothesis of fever 
depending on a change in the state of the 
simple solids, as the natural agents act not 
on the simple but on the living solids, it is 
necessary to suppose a change in the state 
of the latter ; and as this change accounts for 



116 

the phenomena of fever, there is no occasion 
for any other supposition; and farther, as all 
natural agents excite a morbid action, and 
as this effect is not confined to any one, but 
observed equally in every part of the sys- 
tem, what room is there fo? supposing any 
one pari: is affected more than every other? 
Lastly, with regard to fever being a state of 
accumulated or exhausted excitability, in the 
sense that Dr. Brown uses those terms, it is 
only necessary to refer to the facts which 
prove that no such morbid state exists. It 
is true, that the phenomena of synocha, are 
such as we should expect from an accumu- 
lation of excitability ; but will a surfeit, or 
an excessive quantity of distilled spirits, fre- 
quent causes of synocha, occasion an accu- 
mulation of excitability? 

"It appears then that the living solid is so 
changed, that a change is effected in its laws 
of excitability, and that this admitted, there 
is no occasion for the foregoing hypothesis to 
explain the phenomena essential to fever. 
Upon the whole then, the following, as far 
as it goes, would appear to be a just view 
of the nature of fever. 



117 

•'Every agent, acting on the system in 
general, is capable of producing three ef- 
fects — moderate excitement, excessive ex- 
citement, and atony, according to the degree 
in which it is applied." The first operation 
of agents, produces health; the two last, ge- 
neral disease, which has been called fever. 
If by the application of artificial, or the ex- 
cessive application of natural agents, either 
of the two last states be maintained for a suf- 
ficient length of time, the living solid is so 
much changed, that is, such a habit is form- 
ed, that the natural agents, applied in their 
usual degree, produce certain morbid effects, 
till the diseased habit has been counteracted, 
which, as in other habits, is the more easily 
effected the shorter its duration has been. 
Hence it is, that almost any thing making a 
strong impression, will remove fever at an 
early period ; and hence, the difficulty of re- 
moving a fever, is generally proportioned to 
the time it has lasted. The means which 
cure a fever at an early period, that is, pro- 
duce a crisis, seem either to expel the mor- 
bific cause before the morbid habit is effect- 
ed : as vomiting during a tit of drunkenness, 



118 

or break the morbid habit before it has gain- 
ed force, as cold bathing during the first days 
of fever. In the more advanced stage, as 
the morbid habit is corrected with more diffi- 
culty, it is corrected more slowly. 

" Whmin synocha, we succeed in changing 
excessive excitement to moderate excitement, 
i. e. that excitement which is followed by 
exhaustion, we have removed the morbid 
habit and of course cured the disease. 

" The cure of synocha, therefore, depends 
on the abstraction of stimuli ; but as atony 
is the consequence of excessive excitement, 
if excessive excitement has lasted for any 
considerable time, atony will always be evi- 
dent, previously to the restoration of health : 
hence it is, that the symptoms of typhus (so 
frequently) succeed those of synocha. 

"When we succeed in changing atony 
into moderate excitement, we have corrected 
the morbid state, and consequently cured the 
fever. The cure of typhus, therefore, de- 
pends upon the due and judicious applica- 
tion of appropriate stimuli, repeated at short 
intervals. " 

From the preceding statement, it appears 



119 

that every form or variety of fever may be 
considered as depending on irregular excite- 
ment, and requires to be treated according 
to the particular indications of excessive or 
defective action of the heart and arteries; 
and not, as taught by Brown, conformably to 
any graduated scale of stimulation. 



rn 



rhe following is the substance of the doc- 
trine of diseases, of the late celebrated 
and ingenious Dr. Benjamin Rush, Pro- 
fessor of the Institutes and Practice of 
Physic, in the University of Pennsylva- 
nia, which he delivered in his lectures 
with so much eloquence, and in so ele- 
gant a style, that almost every one who 
heard him, embraced his doctrine with a 
degree of conviction, that is usually pro- 
duced only by mathematical demonstra- 
tion. 

"As in health," says Dr. Rush, "there 
exists a constant and just proportion between 
the degrees of excitement and excitability, 



120 

and the force of stimuli, so, in a predisposi- 
tion to disease, (which predisposition con- 
sists in debility, and an undue proportion of 
excitability, or preternatural susceptibility 
to the impression of stimuli or exciting pow- 
ers,) the ratio between the force of stimuli, 
excitement, and excitability is destroyed; in 
consequence of which, stimuli act with a 
force, which produces irregular action. And 
when the excitability is comparatively more 
abundant in the blood vessels than in the 
other portions of the system, which, from 
their being distributed in numerous and mi- 
nute branches to every part of the surface of 
the body, both internal and external, is fre- 
quently the case, from the operation of the 
remote or predisposing causes of fever, mor- 
bid, irregular, or convulsive action is pro- 
duced in them, by the stimulus of distension 
from the circulating blood ; for the equili- 
brium or due adjustment between the dif- 
ferent portions of the system having been 
previously destroyed or changed, by the sud- 
den diminution of excitement, in consequence 
of the abstraction or suspension of the natu- 
ral and customary stimuli, or from any cause 



J21 

which has operated with such violence as 
to diminish their excitability suddenly, the 
blood becomes unequally distributed,, and by 
acting with an increase of quantity and force 
iti parts not accustomed to either, becomes 
an irritant to the muscular fibres of the heart 
and arteries, and thus an exciting cause of 
fever/' 

Dr. Rush asserts, that both direct and in- 
direct debility, (the former of which, he de- 
nominates debility from abstraction, and the 
latter, debility from too powerful or long 
continued action,) are always succeeded by 
increased excitability, or greater aptitude to 
be excited into action by stimuli, and that 
the different forms or descriptions of fever 
are entirely owing to the disproportion sub- 
sisting between the stimulus received from 
or communicated by the circulating blood, 
and the quantity of excitability or aptitude 
of the muscular fibres of the arteries to be 
excited into action by the application of that 
stimulus. His opinion, relative to -debility 
being the predisposing cause of every form 
or description of disease, is thus stated in 
the last edition of his "Medical Observa- 

L 



122 

tions and Enquiries i% u Indirect debility, as 
well as direct debility, is followed by an in- 
crease of excitability, when it is suddenly 
induced, or brought on by the violent and 
rapid operation of stimulating agents; and 
direct and indirect debility are on a footing, 
when they are of a chronic nature. In both, 
the excitability is equally expended, and the 
system is left in a state in which stimuli act 
with too little force upon it to excite in it 
the commotions of fever. 

"In any variety or form of acute diseases 
(he says) occasioned by the causes which in- 
duce either direct or indirect debility, the 
debility induced, is succeeded by increased 
excitability; but this increased excitability 
is not equally diffused through the system, 
but is most abundant in such parts as have 
been most debilitated by the operation of the 
remote causes; hence the concentration of ir- 
regular action, and morbid excitement, that 
follows the application of dispropriate sti- 
muli;" (that is, of stimuli too strong or too 
weak for the state of the existing excitabi- 
lity.) 

In this circumstance, as well as in that 



123 

respecting predisposition to disease, the theo- 
ry of Dr. Rush differs materially from the 
theory of Dr. Brown, though it more near- 
ly agrees with that of the late Dr. Darwin in 
this particular; for Dr. Brown supposes that 
idiopathic fevers, or those fevers in which 
the whole system is affected without being 
connected with, or dependent on the affec- 
tion of any particular organ, the excitability 
is equally redundant or defective in every 
part of the system, proportioned to the de- 
gree of the previous action or abstraction of 
the remote causes, and is not confined or 
concentrated in any one particular portion 
or part, more than another; and that the ac- 
tion of stimuli on any one part, extends its 
effects, in a proportionate degree, to every 
other part at the same time. Dr. Rush, on 
the contrary, supposes that the susceptibility 
to the impression of stimuli (which has re- 
ceived the name of excitability from Dr, 
Brown, and of the diffused matter of life 
from the celebrated Sir John Hunter, and 
the sensorial power or spirit of animation 
from Dr. Darwin,) exists in a greater quan- 
tity in the parts that have been most debili- 



124 

iated, in consequence of the operation of the 
remote causes; all of which? he says, occa- 
sion a predisposition to disease by their de- 
bilitating effects, either in consequence of the 
abstraction of natural and customary, or the 
excessive action of preternatural stimuli, or 
stimuli to which the patient has not been ac- 
customed; and adds, that all the predispos- 
ing causes of disease, whether it appears in 
the form of phlegmasia or typhus, are debi- 
litating, differing only in degree, and that 
all the exciting causes, or those which in- 
duce irregularity or morbid action in the sys- 
tem, are stimulating. — and that all the diffe- 
rence in the symptoms, proceeds from the 
difference in the quantity or condition of the 
excitability, and the force or numbers of the 
stimulating agents applied, or in operation. 

Among the remote or predisposing causes 
be enumerates, with the generality of syste- 
matic writers, cold and moist air, fatigue, 
from too much exercise, fasting or abste- 
mious living, immoderate evacuations, de- 
pressing passions of the mind, all of which 
produce debility, or a defect of healthy ex- 
citement, by the abstraction of natural and 



185 

customary stimuli, in consequence of which, 
the excitability increases and becomes super- 
abundant. A similar increase and accumu- 
lation of excitability, he says, also takes 
place soon after, suddenly withholding or 
abstaining from the artificial stimuli of strong 
liquors, or highly seasoned aliment, that a 
person has been long accustomed iv. But 
that in the generality of the different forms 
of disease, the phenomena or symptoms pro- 
ceed from the excitability being more abun- 
dant in one part of the system than another, 
in consequence of the remote causes having 
produced greater debility in one part, than 
in the rest of the system. Hence, the blood 
vessels being more exposed to the alternate 
effects of cold and heat than the other por- 
tions of the system, from their being distri- 
buted in numerous and minute branches to 
every part of the surface of the body, both 
internal and external, they become propor- 
tionably more debilitated, and of course, their 
excitability becomes greater than in any 
other part of the system; in consequence of 
which, they become the seat of fever,, the 



126 

proximate cause of which, is an irregular ae~ 
lion or convulsion of their muscular fibres. 

*' lie debility, and consequent ex- 

citaMtit^, are equally diifused through the 
arterial system, the disease will not be ac- 
companied with any local affection ; but when 
the arteries of any particular viscus or or- 
gan are more debilitated and more excitable 
than in the rest of the system, an inflamma- 
tory affection will be induced in the organ 
so debilitated and excitable; therefore, as in 
all ordinary cases of fever it is seated in the 
blood vessels — all those local affections called 
pleurisy, angina, phrenitis, hydrocephalus 
internus, phthisis pulmonalis, hepatitis, gas- 
tritis, enteritis, rheumatismus, hydrothorax, 
ascites, &c. ought to be considered as symp- 
toms only of an original or primary disease 
in the sanguiferous system." 

The peculiarities in these states of fever, 
and the circumstances in which they differ 
from fever unaccompanied with local inflam- 
mation, we are told, depend, 1st. upon local 
debility and increased excitability, the con- 
sequence of that debility, in the part princi- 
pally affected. And 2dly. upon the morbid 



- 127 

excitement induced in the part where the ex- 
citability predominates, by the stimulus of 
distension from the blood, and by the effu- 
sion of serum, lymph, and red globules in 
the weakened, excitable, excited, and after- 
wards inflamed part. 

We are also told, that disease, seated in 
any other portion of the system, depends on 
the same cause as fever, viz. debility and ex- 
cess of excitability; and that its phenomena 
or symptoms are more or less strong and ma- 
nifest, in proportion to the quantity or state 
of the existing excitability, which becomes 
greater or less in proportion as the debility, 
induced by the remote or predisposing causes, 
has been greater or less, and the greater or 
less force of the acting stimuli or exciting 
causes; and consequently, that the cure of 
every form or variety of disease is to be ef- 
fected, or at least attempted, by the removal 
from, or guarding against the application of 
the remote or predisposing causes, and in ad- 
justing the force of the existing and natural 
stimuli, as much as possible, to the state of 
the debility and existing excitability predo- 



128 

minani in any particular portion of the sys- 
tem. 

Among the occasional or exciting causes 
of disease, and especially of fever, Dr. Rush 
enumerates sensible heat, marsh miasmata, 
human effluvia, the contagious matter of erup- 
tive fevers, poisons of all kinds, excess in 
eating and drinking, sudden emotions of the 
mind, bruises, burns, &c. all of which, he 
says, act by their stimulating power only, in 
the production of disease. And, although 
he acknowledges that fever is often the con- 
sequence of debilitativg causes, without the 
application of any apparent stimulus, he is of 
opinion that the circulating blood is suffi- 
cient, in such a state of excitability, to sti- 
mulate the heart and arteries to more fre- 
quent and irregular action. 

In treating of the proximate cause of fe- 
ver, we are told by Dr. Rush, that "fever 
is a modification of disease, which has its 
seat in the blood vessels, and consists in an 
irregular action or convulsion of the arteries ; 
and that this convulsion of the arteries is the 
proximate cause of fever." This, in com- 
mon language, is making the disease and 



129 

proximate cause the same. But this is a vio- 
lation of the rules of logic, in which it is 
laid down as a maxim, that cause and effect 
are never to be indentified. The irregular 
action or convulsion of the arteries, in which 
we are told fever consists; cannot be the 
proximate cause of fever, otherwise it would 
be the cause of itself. 

If that were possible, every event that oc- 
curs in the universe might be the cause of 
its own existence, which is contrary to ex- 
perience and therefore inadmissible. 

The proximate cause of a disease, accord- 
ing to the correct signification and true mean- 
ing of the term, is that cause which is nearest 
to the effect; and, in medical language, means 
that condition or circumstance on which dis- 
ease or a deviation from health directly de- 
pends; or from whence the symptoms flow, 
and which necessarily cease to exist on the 
removal of that condition or circumstance. 

If, therefore, the theory of Dr. Rush were 
correct, and he reasoned consistently with its 
principles, in my opinion, he ought not to 
have considered the convulsion of the arte- 
ries as the proximate cause, but as the proxi- 



136 

mate effect of the stimulus of distension from 
the blood acting upon the increased excita- 
bility of the arteries ; for, according to his 
own expressions, "the irregular action of the 
arteries is owing to the action of the stimulus 
being disproportioned to the increased exci- 
tability." 

A strong objection rises against the opi- 
nion of the arteries being the primary seat of 
fever, from the phenomena which are ob- 
served to precede and accompany the cold 
stage of the generality of fevers, unaccompa- 
nied by topical inflammation. 

The cold stae;e of fever cannot be account- 
ed for, in a satisfactory manner, on the prin- 
ciples of either this doctrine, or on those of 
Dr. Brown or Darwin. 

Dr. Cullen's account of the cause of this 
stage of fever is much more plausible, though 
it fails most egregiously in accounting for 
the hot stage. 

It is evident, from the circumstance of the 
symptoms of fever immediately subsiding, 
upon the removal of any topical inflamma- 
tion existing in any of the viscera, that the 
proximate cause of simple fever and that of 



LSI 

inflammation are not the same: though they 
both betray symptoms of irregular action in 
the arterial system; otherwise the symptoms 
of fever would still be continued by " the 
stimulus of distension from the circulating 
blood/' after the reduction of the topical in- 
flammation, until the excitability of the part 
originally affected, and that of the rest of the 
arterial system, became adjusted, or in due 
proportion to each other. That the symp- 
toms of lever, accompanied by topical in- 
flammation, do cease upon the removal of the 
inflammation, is a fact too familiar to every 
one that has seen practice, to be contested. 

The fever which accompanies local in- 
flammation, and which is generally accom- 
panied with strong and frequent arterial ac- 
tion, is certainly a very different disease from 
fever unaccompanied with local inflamma- 
tion. It differs from simple fevec in depend- 
ing upon the local inflammation, which is its 
exciting cause. From this, it has its origin, 
and with the removal of this, as observed 
bj the accurate and experienced Fordyee, it 
terminates. 

The regular increase and decrease of the 



paroxysms of an intermittent fever; its spon- 
taneous and often sudden termination, with- 
out any change that can be perceived or rea- 
sonably supposed to have taken place in the 
debility, and subsequent increase of excita- 
bility, in the arterial system, and at a time 
when the general debility of the patient has 
increased to an extreme degree, is a strong 
argument that intermittent fever, or that form 
of fever so called, has not its seat primarily 
or exclusively in/the arterial system; on the 
contrary, from the affection of the nervous 
system, and from the phenomena which pre- 
cede and accompany the cold or forming 
stage, it may be inferred that the nervous 
system is equally, if not more concerned in 
its existence and continuance, than the ar- 
terial system. 

As the most certain method of ascertain- 
ing the correctness of any theory or doctrine 
of diseases, is to subject it to the test of ex- 
periment, and by comparing the effects that 
would necessarily result from the application 
of its principles to practice, with a mode of 
practice universally admitted to be benefi- 
cial, I will now proceed to inquire what 



133 

would he the probable effects of the applica- 
tion of the theory under consideration, for 
the removal of diseases. 

If debility, as inculcated by this doctrine, 
is always, in acute diseases, succeeded by 
increased excitability or a greater aptitude to 
be excited into action by stimuli, and the 
different forms of fever* with all their vary- 
ing symptoms, were only owing to the dis- 
proportion subsisting between the stimulus 
of distension from the circulating blood, and 
the quantity of excitahility or aptitude to be 
excited into action by the application of sti- 
muli, the remedies which have been observed 
to be the most efficacious in the typhus, and 
the acute rheumatism, should be reversed; 
because, as the debility which precedes and 
accompanies the typhus through its course, 
is much greater than that which precedes 
and accompanies the acute rheumatism, the 
excitability in the typhus must greatly ex- 
ceed that in the rheumatism. Therefore, to 
act consistently with this doctrine, instead of 
applying stimulants in the typhus, stronger 
than those which the patient has been accus- 
tomed to, when in health, those which sti- 

M 



134 

mulate less should be employed, and the 
quantity of his blood dimn shed, to propor- 
tion the stimulus of distension to the state or 
quantity of the excitability; whereas, in the 
rheumatism the stimulating medicines should 
be increased without any reduction of the 
quantity of his blood, that the stimulus of dis- 
tension might reduce the excitability to a due 
ratio with the stimuli. 

We learn, however, from the most unex- 
ceptionable experience, that such practice 
would be highly inefficacious and improper. 
Similar would be the effects of the ap- 
plication of the principles of this theory to 
tetanus, scurvy, colic, asthma, dropsy, and 
all the varieties of disease that belong to the 
asthenic or atonic class. 

It may therefore be concluded, that the 
principles from which this doctrine is de- 
rived are incorrect, or that the author of the 
theory has not explained it with that clear- 
ness and accuracy that its importance re- 
quires. 

If the principles of this doctrine were cor- 
rect, when the excitability on which certain 
forms of disease depend; existed to excess in 



135 

one portion or part of the system, the dis- 
ease might be cured by creating an artificial 
debility in a different part, that it might flow 
into it from that where the disease has its 
seat; for, by this method, we are informed 
by Dr. Rush in his notes on Pringle's Dis- 
eases of the Army, "purgatives, by inducing 
an artificial debility in the intestines, with- 
draw the excess of excitability from the joints 
in cases of chronic rheumatism, and thus 
equalize the excitement between the differ- 
ent parts of the system." 

If it was the effect of purgatives, as sup- 
posed by Dr. Rush, to withdraw the excita- 
bility from the joints and lodge it in the in- 
testines, the practice would be highly objec- 
tionable; because, if the artificial debility 
produced by them in the intestines, withdrew 
the excess of excitability from the joints, it 
would also withdraw a proportionable quan- 
tity of excitability from every other part of 
the system at the same time; in consequence 
of which, an excessive quantity would flow 
to, and accumulate in the debilitated intes- 
tines, and consequently, induce in them a 
more violent disease, or at least a disposi- 



136 

Hon to a more violent disease, than the one 
that would be removed by such means; for, 
according to this doctrine, debility, in con- 
junction with an increase of excitability more 
predominant in one part of the system than 
in the rest of it, and stimuli, disproportioned 
in power or force of impression to the state 
of the existing debility, are the main links 
in the chain of the causes of every form or 
variety of disease. 

If it was a fact, that the increased fre- 
quency of action, which, for the most part, 
takes place in every variety of fever, is ow- 
ing to an increase or accumulation of excita- 
bility in the muscular fibres of the heart and 
arteries, it might be expected that this ac- 
tion is to be diminished, either by prevent- 
ing the system from' furnishing those parts 
with their usual supply, by those means 
which have the effect of diminishing the en- 
ergy of the sensorium, as well as of the heart 
and arteries at the same time ; and the means 
best adapted to produce this effect would be 
abstinence from aliment, and every kind of 
drink but cold water, and by diminishing the 
quantity of blood by venisection, &c. 



137 

But these means, in cases of typhus gjj^- 
vior, or the malignant forms of fever, instead 
of removing the disease, aggravate all the 
symptoms, and endanger the life of the pa- 
tient. The theory, therefore, of the arterial 
system being the primary and principal seat 
of idiopathic fever, and that the excitability 
in that portion of the system is in much 
greater quantity than exists in them in a state 
of health, aud especially in that form or spe- 
cies of fever denominated typhus, is highly 
improbable. 

If, in such cases, the excitability was ac- 
cumulated to excess in the blood vessels, in- 
stead of having recourse to affusions or ab- 
lutions with cold water, to abstract and di- 
minish the stimulus of sensible heat, the uti- 
lity of which has been sanctioned by repeat- 
ed and extensive experience, Ji unin's ma- 
chine for the application of dry heat would 
be much more efficacious: because, a stimu- 
lus stronger than usual, applied to the mov- 
ing powers of the body, makes them, after 
such application, much less easily excited 
into action by the natural and customary sti- 
muli ; and, on the sudden abstraction of the 

m 2 



138 

stronger and extra stimuli, the motions of the 
part where the disease has its seat would be 
less forcibly excited. 

Dr. Rush in his defence of blood-letting 
states, that a dissolved appearance of the 
blood, in that form of fever which he deno- 
minates malignant, "is a sign of the highest 
degree of excitement and strength of action 
in the blood vessels, and that its dissolved 
appearance is owing to the immoderate ac- 
tion of tlie arteries upon it, which rend and 
tear it to pieces. " 

To shew that this ingenious and expe- 
rienced physician has mistaken the cause of 
this condition and appearance of blood, I 
need only appeal to those who have had op- 
portunities of examining the blood, drawn in 
the latter stage of phrenitis, pleurisy, or rheu- 
matism, and have compared it with that 
drawn in the latter stage of the typhus gra- 
vior, yellow, spotted, or any other form of 
malignant fever. In the former cases, the 
blood, while cooling, separates into serum 
and crassamentum, and becomes almost in- 
variably covered with a thick, tough, white, 
or buff-coloured substance, resembling size, 



139 

jelly, or glue; whereas, in the latter stage of 
a malignant Sever, even in cases which begin 
with strong arterial action, the blood in a 
late stage of the disease, does not separate 
into serum and erassamentum, but remains 
one uniform homogeneous fluid, resembling 
coloured water; though, in the diseases first 
mentioned, the force and action of the arte- 
ries are unequivocally many degrees stronger 
than they are ever observed in cases of the 
most malignant fever. 

If marsh miasmata and human effluvia^ 
acted by a stimulating property, in the pro- 
duction of fever, as taught by Dr. Rush, they 
would produce similar effects with other di- 
rect stimuli, and their action would be prin- 
cipally confined to the arteries, rendered pre- 
ternaturally excitable by the abstraction of 
natural stimuli, or the excessive action of ar- 
tificial stimuli; an increase of power, or at 
least of actiou, would appear in them the in- 
stant the miasmata were received into the 
system, and came in contact with the muscu- 
lar fibres of the arteries : but we learn, from 
accurate observation, that this is not the 
case; for persons that are exposed in situa- 



140 

(ions where marsh miasmata, or the exhala- 
tions from putrefying vegetable and animal 
substances, are most abundant, and under 
circumstances which dispose them most rea- 
dily to be acted upon, perceive no sensible 
effect for several days after such exposure, 
or after exposure to the contagious exhala- 
tions from eruptive fevers. A period always 
intervenes of different length on different oc- 
casions, but always of sufficient length, after 
such exposure, before any effect is perceiv- 
ed or any alteration observed, especially in 
the arterial system, to convince any one that 
is qualified to discern the relation between 
cause and effect, that these causes of fever 
do not act primarily on the arteries, or pro- 
duce their effects by a directly stimulating 
action upon the excitability of the system. 
The symptoms of the forming, or early stage 
of the fever, by no means indicate that they 
are the effect of stimuli, whose primary ac- 
tion is upon the muscular fibres of the heart 
and arteries, (which would in part be a re- 
vival of the exploded doctrine of morbific 
matter,) for those symptoms always indicate 
defect or depression of power in the muscles 



141 

that are subservient to the will, in a state of 
health for some time before an increase of 
motion or disordered action is perceivable in 
the arterial system ; though from a law of the 
animal economy which, 1 believe, has neve* 
been perfectly explained, this state of depres- 
sion is soon after followed by an increase of 
action, and frequently of strength, in the ar- 
terial system. 

If the miasmata acted primarily on the sto- 
mach, as taught by Dr. Darwin, and expend- 
ed excitability by excessive action, all the 
functions of the body would shew signs of 
vigour the instant it began to act on the ex- 
citability of the stomach, before it was fol- 
lowed by symptoms of exhaustion, in the 
same manner as they do upon receiving wine, 
alcohol, or other strong stimuli into it; or, if 
they acted with the force and celerity of the 
electric fluid, a prostration of strength and 
suspension of excitability would be the im- 
mediate consequence. 

According to the legitimate rules of induc- 
tive philosophy, it cannot be admitted that 
marsh miasmata, or the volatile substances 
derived from putrefying vegetable and animal 



143 

substances, when received into the human sys- 
tem, act as stimulants, and produce indirect 
debility, by expending or impairing the ex- 
citability, by a stimulating action or impres- 
sion; because, we see fever more certainly 
produced after exposure to those miasmata, 
by the abstraction, than the moderate addi- 
tion of certain stimuli — such as the abstrac- 
tion of the heat of the body, by exposure to 
the moist and cool air, so common at night, 
particularly when aided by abstinence, or 
too scanty supply of aliment and refreshing 
drinks, and unusual fatigue, previously to 
such exposure. The previous stimulating 
power or property of these miasmata have 
never been perceived by the patient, and the 
very slow progress and diminution of power 
indicated by the symptoms, previous to the 
accession of the exacerbation or hot stage of 
fever, in cases of intermittent fever, are 
strong arguments against its being a fact, and 
against the correctness of the doctrine. 

If the theory of disease, which was taught 
by this ingenious and eminent professor, was 
correct, every form or variety of disease 
would require such remedies as have the of- 



143 

feet of inducing artificial debility in otber 
parts of the system, greater than that whieh 
exists in the part where the disease is seat- 
ed, that the surplus of excitability might be 
drawn from the part primarily affected, and 
conveyed into other parts, where it was defi- 
cient, and the excitement thereby, equalised 
throughout the system. But if every form 
or variety of disease consists in different de- 
grees of excitement, above or below the point 
of health, as taught by Drs. Brown and Dar- 
win, aud in the different degrees of irregular 
action, as taught by Dr. Rush, and these dif- 
ferent degrees of irregular action, depend 
upon the unequal quantity of excitability in 
different portions of the system, or in diffe- 
rent parts of the same portion, and a dispro- 
portion between the excitability thus unequal- 
ly accumulated and the force of the stimuli 
which act upon it, and the excitability becomes 
more abundant, in proportion to the abstrac- 
tion of natural and customary stimuli, as well 
as in consequence of the excessive action of 
stimuli, after such action has been suspend- 
ed for some time, either the theory or prac- 
tice recommended by Dr. Rush must be 



144 

wrong — for blood letting and other deplet- 
ing remedies, which he recommends in dis- 
eases which indicate too much excitement or 
too strong action, by promoting artificial de- 
bility in the heart and arteries, would occa- 
sion a preternatural flow and increase of ex- 
citability into them, and consequently, in- 
crease the cause on which their convulsive 
action depends. 

The creed that excitability increases, or 
that the susceptibility to the impression of 
stimuli becomes greater in proportion to the 
degree of debility induced by the operation 
of the remote causes of fever, or, in conse- 
quence of suddenly withholding or suspend- 
ing the action of artificial stimuli, as respects 
the heart and arteries, is not only hypotheti- 
cal, but is contradicted by facts that are fa- 
miliar to every practical physician. In the 
last stage of the typhus fever, for instance, 
and in many cases, from its very commence- 
ment, (late examples of which have been nu- 
merous in the states of Connecticut and Mas- 
sachusetts, and in the western parts of New 
York,) -when the symptoms indicate great 
debility, as well as in the asthma and colic, 



145 

instead of a corresponding or proportionable 
degree of excitability, the deficiency of exci- 
tability is so great as to require the most 
powerful and penetrating stimuli to arrest 
the ebbing tide of life ; whereas, in most 
cases of fever accompanied with, or depend- 
ing on local inflammation, the mildest stimu- 
li increase the force and frequency of the 
heart and arteries, and exasperate the symp- 
toms. 

If the power of both the vital and animal 
functions, become impaired or diminished; 
in consequence of the abstraction of a due 
portion of pure and fresh air, long fasting, 
fatigue, and exposure to a lower temperature 
of the atmosphere than usual, or from the 
abstraction of other stimuli which habit has 
rendered necessary to support the healthy 
action of the system ; or from suddenly ab- 
staining from strong artificial stimuli, that a 
person has been long accustomed to, can it 
be said, with any degree of probability, that 
the excitability or principle of animation, un- 
der such circumstances, has gone on to in- 
crease and accumulate in the system, and 
that because it has not been expelled or ex- 



146 

liausted by the strong and more frequent ac- 
tion, which the application of stimuli occa- 
sions, it must have increased and accumu- 
lated. 

In my opinion, we might with equal rea- 
son, expect an effect without a cause; for it 
would be highly irrational, and incompatible 
with observation, to expect that the excitabi- 
lity or principle of life, the production and 
renewal of which, requires the functions of 
health, should be generated and accumulated 
in greater abundance, while the system la- 
bours under a state of diminished power, as 
it apparently always does for a longer or 
shorter time, previous to, and at the time of 
the accession of fever. The probability is 
much greater, and more consonant to reason, 
that the torpor and impaired state of strength 
in the voluntary muscles, which precede the 
invasion of fever, would, in a great measure, 
prevent any additional productive increase 
or accumulation of the excitability. 

According to this doctrine, as well as to 
tho^e of Drs. Brown and Darwin, the exci- 
tability or principle of life, which is a sub- 
stance or quality, the existence of which is 



147 

only known from its effects, becomes increas- 
ed in proportion to the deprivation of every 
thing necessary for its production and sup- 
port; for, as the powers which support life 
are diminished, life itself is increased, which 
is extremely improbable, as well as unac- 
countable; because every effect must neces- 
sarily be preceded by, or connected with an 
adequate cause. Nor does this doctrine cor- 
respond with facts; for it is notorious that 
the phenomena of remittent and typhus fe- 
vers, especially when they have a tendency 
to terminate fatally, indicate that the excita- 
bility, instead of increasing or accumulating 
in a greater proportion as the debility in- 
creases, particularly in the vital functions, 
keeps regular pace with it, or diminishes in 
an equal proportion as the debility increases. 
Dr. Rush's directions, and the remedies he 
recommends for reducing the excitement 
when too high, and raising it when too low, 
in every modification of disease, without be- 
ing influenced by the name by which they 
are called in the different systems of nosolo- 
gy, which is certainly the only true method 
of practising with success in the generality 



148 

of diseases, furnish a most unanswerable ar- 
gument against the fundamental principles of 
his theory. I expect the following facts and 
enumeration of symptoms and circumstances 
connected with that description of continued 
fever denominated typhus gravior, which, 
with some alterations, are extracted from 
Dr. Mihnan's Enquiry into the Nature and 
Sources of the Scurvy, and of (what he 
calls) Putrid Fevers, published in the year 
1783, will satisfy every impartial reader, that 
instead of there being an increase of excita- 
bility in the muscular fibres of the heart and 
arteries, their excitability is in an impaired 
or diminished state. 

" Though the manner in which the various 
motions of the body are performed, as well 
as the more intimate structure of its fibres, 
may be forever concealed from us; yet there 
are certain properties of these, taught us by 
experiment, the existence and true use of 
w T hich, are as well ascertained as any part of 
human knowledge." 

That property of the muscular fibre by 
which, on the application of a stimulus, it is 
enabled to move and contract itself, is known 



149 

to be derived from a principle inherent in its 
fib.e, and which, to a certain degree, conti- 
nues to exist after all connection is cut off 
between it and the nerves. For though the 
destruction of this principle in the muscular 
fibres, is the certain and immediate death of 
those fibres, yet there are many causes which 
may take away sense and motion, and may 
leave this principle surviving in the muscu- 
lar fibre ; so that when all sense and motion 
in the animal machine has ceased, and inter- 
nal stimuli can no longer be applied, we can 
for several hours, and in some particular ani- 
mals for several days, by external stimuli, 
excite the muscular fibres to contraction, in 
consequence of this principle not being yet 
extinct in them. 

The voluntary and involuntary motions 
of the body, are all dependent upon this 
principle. — It is by means of it, that the 
muscular fibres of the heart, being stimulated 
by the blood flowing into its auricles and 
ventricles, are made to contract or react, and 
to propel the blood. The same vital power 
in the voluntary muscles, being acted upon 
by the nervous power directed to them by the 

n 2 



150 

will of the animal, renders them obedient to 
its purposes. The vital principle is the ef- 
ficient or proximate cause, whilst the stimu- 
li applied, are only the exciting cause of their 
motion; for, when the vital principle is de- 
stroyed, no motion can be excited in either 
the voluntary or involuntary muscles by any 
stimulus whatever. 

Fontana, the ingenious and celebrated 
Italian philosopher and physiologist, has 
examined very attentively the effects of many 
of those causes which have a power of im- 
pairing the vital principle, and upon the 
grounds of extensive and judicious experi- 
ments, affirms it to be an universal law of the 
animal economy, that the diminution or de- 
struction of the vital principle in the muscu- 
lar fibre, gives it a tendency to putrefaction, 
and that this tendency will be greater or 
less, in proportion to the force and quick- 
ness with which the cause destroying this 
principle operates. Where the cause is less 
powerful, and more slow in its operation, and 
we have time to note with accuracy all the 
phenomena which succeed the injury of the 
vital principle, it is observed that the first ef- 



151 

feet of the diminution or impaired state of it, 
is a weakness of the muscular fibre; so that 
stimuli which could have excited it in health 
to strong contractions, can only produce weak 
ones. 

An examination of the symptoms of the 
mildest cases of typhus fever, must satisfy 
every unprejudiced inquirer, that its occa- 
sional cause has induced such a weakness in 
the muscular fibres, as to prevent stimuli, 
which, in health, were capable of exciting 
strong contractions in the voluntary and in- 
voluntary muscles, from being able to pro- 
duce any other than feeble ones. It is also 
observable in more malignant or dangerous 
cases of this form of fever, that the fibres be- 
come soft and relaxed ; the cohesion between 
the particles composing the fibres are dimi- 
nished, so that the fibre breaks upon moderate 
pressure or extension — the extreme arte- 
ries appear paralytic, so as to let the blood 
escape, and the blood itself loses its power 
of coagulating when drawn from a vein. But 
if, (pulsus fterumque frequens;) the pulse 
for the most part, is increased in frequency, 
as stated by Dr. Cullen, and is admitted to 



15& 

be the case in the beginning of most of the 
varieties of the typhus fever, be a just part 
of the character of this disease, may we not 
conclude, that however the vital principle 
may be impaired or diminished in the volun- 
tary muscles, so far from being impaired or 
diminished in the heart and arteries, it is in- 
creased. This would be to suppose that the 
cause which diminishes the vitality or exci- 
tability in the voluntary muscles, may in- 
crease it in the involuntary ones. This 
would also be making the quickness or fre- 
quency of the contractions oi the heart and 
arteries, the measure of the vital power in 
their fibres. He who should calculate the 
power of the heart and arteries, and judge 
of the quantity of the existing excitability in 
their fibres, without taking into account either 
the stimuli applied to excite their contrac- 
tions, or the force and effect of these con- 
tractions when produced, I presume, would 
he as little likely to form a just estimate of 
the vital power existing in their fibres on 
which their contractions depend, as that per- 
son would be of having an accurate idea of 
the weight of a moving body, who, without 



153 

considering the quantity and density of the 
matter it contains, should measure it merely 
by its velocity. To draw just conclusions, 
therefore, from the quickness of the pulse, 
we must examine the sources from which it 
may arise. 

As the vital power appears in these cases 
to be generally diminished in the system, it 
does not appear any way probable that it 
should have suffered no local injury in the 
fibres of the heart. Instead, therefore, of 
proceeding from increased excitability accu- 
mulated in the fibres, from having been pre- 
viously debilitated by the remote causey 
may not the quickness of the pulse be ocea» 
*ioned by increased irritation? 

A minute investigation of this matter, will, 
in my opinion, teach us that instead of being 
more irritable, the quick and feeble motion 
of the vital organ only indicate that it is more 
irritated. 

It is generally admitted that the blood 
which flows into the auricles and ventricles 
of the heart, is the stimulus which excites 
ihem to contract, particularly that portion 
which is oxyginated in the act of respiration^ 



151 

and the effect is always found to be propor- 
tioned to the quantity and condition of the 
blood which enters, and the force with which 
it flows into the auricles and ventricles of 
the heart. 

When, at the beginning of a paroxysm of 
an intermittent fever, a constriction and pale- 
ness appear on the surface of the body, du- 
ring which the blood is detained and accu- 
mulated in the heart and large trunks of the 
arteries, the pulse becomes, during the cold 
stage, very small, frequent, and irregular; 
the heart seems for a while to labour under 
the load of blood accumulated in, and dis- 
tending its cavities : but the vital principle in 
its fibres not being much, if any, impaired, by 
the occasional cause of the disease, the blood 
which accumulates within its cavities, by the 
stimulus of distension, soon excites it to 
strong, as well as frequent contractions, by 
which the blood is propelled with force to 
every part of the body, and all the symp- 
toms of the hot fit, the heat and redness of 
the skin, &c. ensue. As the heat comes on, 
the heart having relieved itself in some de- 
gree, the pulse becomes more regular and 



155 

full, and in these respects increases, until a 
sweat breaks out. As the sweat flows, and 
as the circulation becomes equable in every 
part, and the heart is no longer stimulated 
by the blood accumulated from a confined 
state of the circulation, the pulse becomes 
softer and less frequent. 

But in that species of fever formerly call- 
ed nervous or putrid, and now typhus or ma- 
lignant, the vital principle being greatly di- 
minished or impaired, and the actions de- 
pending upon it greatly weakened, the heart 
is unable to free itself from the blood detain- 
ed in the trunks of the arteries and accumu- 
lated in its cavities, which, in that unusual 
quantity, stimulates it, as in the cold fit of 
an intermittent, to small and very frequent 
contractions. In these cases, instead of that 
glowing heat and redness of the skin, which 
is so conspicuous in the hot stage of an inter- 
mittent, the same appearance of constriction 
or stagnation of the blood in the capillary 
arteries on the surface, the same pale or livid 
colour continues, the same ghastly or inani- 
mate countenance is seen in every stage of the 
disease, though frequently in different degrees, 



156 

at different times of the day ; and consequent- 
ly, the same cause, the impaired state or dimi- 
nished quantity of the excitability or principle 
of life, which originally prevented the heart 
and arteries from propelling the blood through 
the extreme arteries into the veins, still con- 
tinues to exist. But this extraordinary cause 
of the detention of the blood in the large ar- 
teries, and in the cavities of the heart, is not 
the only cause of irritation in these cases, A 
resistance to the propulsive power of the 
heart, is also considered by physiologists, 
among the causes which quicken the pulse. 
The weight and powerless state of all the 
voluntary muscles, from the impaired state 
of the vital principle in their fibres, in ma- 
lignant fevers, must furnish a considerable 
obstacle to the propulsive power of the heart, 
which, though less irritable, is much more 
irritated than in a state of health, or in other 
forms of fever. 

The blood, then, accumulated about the 
heart in consequence of the weakness of its 
contractions, and the increased weight of the 
muscles rendered inelastic by the occasional 
cause or causes of the disease, and the in- 






157 

creased resistance thereby given to its pro- 
pulsive power, are causes of uncommon irri- 
tation. In some cases of typhus gravior, the 
vital principle appears to be so much impair- 
ed in the muscular fibres of the heart and ar- 
teries, that the concurrence of the enume- 
rated causes are not sufficient to produce 
quickness of the pulse; but when this quick- 
ness does occur, it cannot be accounted for 
so rationally from any other causes as from 
those which have just been enumerated. 
This is also confirmed by the circumstance, 
that if by stimulating and invigorating reme- 
dies, we can excite the heart and arteries to 
contract, for a certain time, with sufficient 
force to relieve the heart from the load of 
blood detained and collected in its ventricles, 
and to force open the extreme vessels, the 
pulse immediately becomes more full and 
regular, and less frequent. 

But, independent of these suggestions, if 
the sources of uncommon irritatiou have not 
been satisfactorily pointed out, to ascribe 
the frequency of the pulse unaccompanied 
with hardness or fulness, in such cases, to 
an increase or accumulation of excitability in 

o 



158 

the blood vessels, would involve us in the 
most palpable contradictions ; our theory, in 
that case, and practice would be at the great- 
est variance. 

Where the vital principle in the heart and 
arteries, on which their contraction essen- 
tially depends, is but little if any impaired, 
as is frequently the case in an intermittent 
fever, stimuli are useless or injurious ; how 
much more would they be so then in cases 
of typhus gravior, if the excitability became 
greater in proportion as the strength of the 
moving powers decreased, as has been taught 
of late by some of the most ingenious and 
eminent professors and lecturers of the pre- 
sent age. 

So far are stimulating and invigorating re- 
medies from being injurious in cases of ty- 
phus or other forms of fever accompanied 
with great prostration of strength, and low 
weak pulse, that patients, in such circum- 
stances, unaccustomed to wine, aether, and 
volatile alkali, not only bear but frequently 
require such a quantity as at other times 
would occasion an inflammation of the sto- 



159 

inach or brain, or the rupture of a blood ves- 
sel. 

To restore the contractions of the heart to 
a healthy state, we are under the necessity 
to increase the power of its propulsive ac 
tion, first, by strong and frequently repeated 
stimulating agents, and to prevent a return 
of the debility by nourishing and refreshing 
drinks, tonic medicines, and other invigorat- 
ing means. 

With what propriety, therefore, could we 
refer the frequency of the pulse, in which 
the action is so much weaker than in health, 
in cases of typhus fever, to an increase of 
that principle, which we find it so necessary 
to cherish and increase? 

That debility so conspicuous in this form 
of fever, both in the voluntary and involun- 
tary muscles, the petechias or livid spots 
which generally occur in cases that have a 
fatal tendency, the haemorrhages from dif- 
ferent parts of the body, the tendency to gan- 
grene in parts that have been inflamed by 
blisters or sinapisms, are all links of the 
same chain, and are all symptoms of the 
same proximate cause, the impaired state of 



160 

the vital principle or excitability in the mus- 
cular fibres. All these phenomena are ana- 
lagous to those observed by the ingenious 
Italian philosopher and physiologist Fonta- 
na, when the vital principle was intentional- 
ly destroyed by the venom of the viper, by 
the poisonous juices of certain vegetables, 
and by a violent shock of electricity. Weak- 
ness was the first eifect — a soft, tender, flac- 
cid, or loose state of the muscular fibres, a 
diminished cohesion between their particles, 
a lengthening of the fibres followed in suc- 
cession, and were the immediate precursors 
of putrefaction. The tendency and progress 
to putrefaction, in the higher grades of the 
typhus fever, is marked by the same pheno- 
mena; according to the legitimate rules of 
induction, therefore, they are to be referred 
to the same cause — the impaired state or de- 
struction of the vital principle inherent in the 
muscular fibres. 

If there is but one disease, and the whole 
catalogue of diseases to which flesh is heir 
to, are to be considered as an unit, as taught 
by Dr. Rush, because every form or variety 
of disease is accompanied with irregular ac- 



161 

tion, we might conclude by the same mode of 
reasoning, that there is but one medicine, or 
that the whole catalogue of remedies con- 
tained in the materia medica is an unit, be- 
cause every kind and variety of remedy acts 
upon the excitability or living principle. We 
might also conclude that there is but one 
animal, because every animal is a living crea- 
ture; and all animals possess some common 
properties, though the figure, habits, actions, 
and character of some, are entirely different 
from those of every other description : 

"Some being fixed like weeds to perish 
where they grow ; w 

Some destined to grovel in the earth (like 
prisoners in despotic governments,) "shut 
out from the enjoyment of the common air, 
and from the free use of their own limbs." 
"While others spread their light wings, and 
mount into the viewless air." And others 
"a watry race, cleave oceairs briny waves." 

We might also conclude for the same rea* 
son, that plants and animals belong to the 
same class of beings, because, like animals, 
plants have life, and receive support from air 
and water, are invigorated by heat and light, 

o 2 



162 

and are rendered torpid or languid, by cold : 
But how would such a doctrine lead to a 
knowledge of their respective characters, 
properties^ offices, and uses ? 

A doctrine which is not supported and 
confirmed by unquestionable facts and in- 
ductive reasoning, and that does not neces- 
sarily conduct to successful practice, instead 
of being a safe and eligible guide, must tend 
to perplex and mislead the student and in- 
experienced practitioneiv 

An attempt, therefore, to banish from me- 
dical studies a systematic arrangement of 
diseases or nosology, derived from accurate 
and repeated investigations of the nature and 
causes of diseases, (a description of the cha- 
racters or symptoms of which, render those 
of a particular kind or description, easily 
distinguished from those of every other kind 
or description,) and to substitute in its place 
an hypothesis derived from a mere symptom 
or effect of an exciting or occasional cause, 
acting on a state of the system favourable to 
its action, (for irregular action, confined to 
its true meaning, is nothing else,) cannot cer 



163 

tainly be justified on the plea of practical 
utility. 

By the rules of nosology, or systematic 
classification of diseases, the student very 
soon learns to distinguish diseases of a dif- 
ferent nature from one another, and which, 
consequently require remedies not merely of 
a different grade in their qualities, but of a 
different kind; whereas, if he adopts the 
theory of Dr. Brown, or Dr. Darwin, or that 
of the more enlightened, ingenious, and en- 
terprising Dr. Rush, he will, until he has 
by long and diversified experience acquired 
a portion of the discriminating sagacity of 
the last mentioned physician, find himself 
perpetually at a loss to accommodate his re- 
medies to the existing state of his patient's 
excitability, and bring the different portions 
of his system to an unison of action. For no 
man, except by chance, can direct his reme- 
dies with unerring aim, who takes uncertain 
rules for his guide. 

To conclude, though the doctrine of dis- 
eases taught by Dr. Rush, and particularly 
his theory of fever, should appear to accord 
more with the simplicity of the laws of na- 



164 

ture, and to appear to be more ingenious and 
philosophical than any other that has hither- 
to been ushered into light, yet by simplifying 
to such an extreme, and attempting to banish 
nosology or systematic arrangement from 
medical studies, I am apprehensive, that, if 
his theory should be generally adopted, to 
the exclusion of the rules of practice which 
he has recommended, and which are sup- 
ported by the experience and writings of the 
most enlightened physicians of the present 
age, it would have a tendency to reduce the 
exalted science of medicine, which has the 
most important and useful objects for its end, 
to the degraded condition of a conjectural 
and uncertain art, and thereby render confu- 
sion more confused. And as he has declared 
himself an advocate for that part of the doc- 
trine of Brown, which considers life to be a 
forced state, or the mere effect of certain sti- 
muli acting upon the organs of sense and 
motion, and expressly asserts that thought 
and the operations of the mind are as much 
the effect of stimuli acting upon these organs 
as any other phenomena of life, I am appre- 
hensive that it will have a tendency to lead 



16 5 

the untutored mind, as well as the sceptic, 
to conclude that the intellectual principle 
will not survive the death of the body, and 
that when the lamp of life is once extinguish- 
ed, it will never again revive. The incul- 
cation of this gloomy and cheerless doctrine, 
however, was far from the intention of the 
benevolent and philanthropic author; for, in 
his introductory lecture in the month of No- 
vember 1809, he expressly says, "there are 
many strong reasons to believe that the souls 
of brute animals, as well as those of man- 
kind, will exist in a future state, as the di- 
vine bounty discovered in the gift of their 
pleasures would be rendered abortive, un- 
less they were placed in a situation to make 
returns of gratitude for it, in a state of future 
existence." 

If life was a forced state, as has been al- 
ledged, the application of exciting agents 
duly adjusted to the varying state of excita- 
bility would preserve mankind in peipetual 
health, and, as has been already remarked, 
render them immortal; for, instead of being 
forced to die, they would be forced to live 



166 



so long as exciting agents are applied, or 
could be procured. 

To the doctrine that life is a forced state, 
it may be objected that this language con- 
veys very incorrect ideas, for the actions 
which are produced in a living body by sti- 
mulating agents are not the cause of life, but 
merely the phenomena and effects of life, or 
of the action of appropriate stimuli upon the 
principle of life. Life may and does exist 
without the agency of stimuli in a variety of 
substances, such as the eggs of animals, the 
seeds of plants, the solids of torpid animals, 
and, for a time, in those that are deprived 
of sensation and motion by drowning ; and 
in some, after decapitation, particularly in 
rabbits, and guinea-pigs, especially if artifi- 
cial respiration is produced by inflating their 
lungs, as has been lately proved by the ex- 
periments of Dr. Le Gallois of Paris, and 
Mr. Brodie of London. The principle of 
life, therefore, or the efficient cause of the 
phenomena of life, may, and does exist, in- 
dependent of organic action, but organic ac- 
tion cannot be produced ia the human sys- 
tem without the presence of the vital princi- 






167 

pie. The question relative to thought and 
the passions of the mind being the effect of 
stimuli upon the organs of sense and motion, 
I shall leave to the consideration and dis- 
cussion of those that are more conversant 
than myself with metaphysical subjects, and 
shall here, for the present, close my obser- 
vations on the theory and opinions of this 
learned and ingenious professor, who deser- 
vedly held the first rank in his profession, 
and whose talents and industry do credit to 
his country. 

Doctor Gregory, the present learned 
professor of the theory and practice of phy- 
sic, in the university of Edinburgh, has de- 
voted some pages of his memorial to the ma- 
nagers of the Royal Infirmary of Edinburgh, 
relative to the pernicious system of rotation 
in the attendance of the surgeons in that in- 
stitution, to an account and consideration of 
the different sects that have prevailed in me- 
dicine, from the time of Galen, whose sys- 
tem he has stigmatized as being more unin- 
telligible, and where it is intelligible, more 
extravagantly absurd, than any that had pre- 



168 

ceded it, and which, adds this author, of 
course came to prevail universally, till it was 
superseded by the systems of Cullen, Brown, 
Darwin, and the pneumatic chemists of the 
present day; which he trusts will keep us 
all alive and merry for a dozen years at least, 
and when they have served their time, and 
their hour is come, nam omnibus manet nox, 
will give place to others as good in every 
respect, and equally fit to amuse the whale, 
(alluding to an expression of Dr. Cullen, 
"that theory is as necessary to amuse stu- 
dents of medicine as a tub to amuse a 
whale.") 

In the same memorial, Dr. Gregory as- 
serts that he neither is, nor ever was, either 
an empiric or a dogmatist. "He would have 
been a keen dogmatist, but he found at least 
99 in the 100 of medical dogmas were false, 
and many of them stark nonsense. He would 
have been a determined empiric, but that he 
found at least 99 in the 100 of empirical 
facts were as false, and more than that pro- 
portion of their remedies as insignificant or 
as dangerous as any of the dogmas of their 
opponents. 



169 

"He has taught the theory and practice 
of physic in the university of Edinburgh for 
four and twenty years, without once throw- 
ing out a tub to amuse the whale. " " He 
never thought he had ingenuity to make 
such a tub, or dexterity enough to manage 
any of the numberless ready made tubs which 
were floating around him." " He observed 
to his great comfort that he had no occasion 
to take that trouble, as the whale lias always 
found some tub to amuse himself withal, and 
has never yet shewn the least inclination 
either to swallow or overset him and his lit- 
tle bark. 

Notwithstanding the preceding declara- 
tion, if 1 have received correct information, 
Dr. Gregory, at present, teaches in his lec- 
tures, "that as all the symptoms which pre- 
cede the cold or forming stage of fever, un- 
connected with local inflammation, indicate 
a defect of power or energy in the functions 
of the brain, and as all the other functions 
except the heart and arteries depend imme- 
diately upon the functions of that organ, and 
the heart and arteries depend on it also indi- 



rectly through the -medium of the nerves 
which it receives from the medulla spinalis, 
and in a secondary manner, by means of the 
organs of respiration; and as all the other 
functions of the system depend either direct- 
ly or indirectly upon the state of the func- 
tions of that organ for their healthy or mor- 
bid action, it may be reasonably concluded 
that the disorder with which they are affect- 
ed at the commencement of every species of 
fever, proceeds from a defect of energy or 
power in the functions of the brain, as their 
regulator and support; and consequently, 
that the nervous system is the seat of fever, 
and its proximate cause, a defect of power in 
the functions of that organ, and the spasm of 
the extreme vessels in every part of the sys- 
tem, both external and internal, which is so 
conspicuous a symptom of the cold or form- 
ing stage of fever, and which continues to 
subsist, in a greater or less degree, through 
the whole course of the fever, is only a 
symptom or effect of irritation occasioned by 
the circulating fluids on parts rendered pre- 
ternaturally irritable by the operation of the 
remote causes, and is not the cause of either 



171 

the cold or hot stage, or of the febrile symp- 
toms, as taught by the illustrious Cullen." 

If Dr. Gregory had proceeded with an ex- 
planation of the manner in which the hot fit 
is produced by the increased stimulus given 
to the heart and arteries, in consequence of 
the increased respiration which occurs du- 
ring the cold stage, and had pointed out the 
chemical changes produced in the blood by 
means of a quickened respiration, his theory 
would have been complete, and would have 
saved me the trouble of adding any thing far- 
ther on the subject. 



Having thus given an abstract or summa- 
ry view of the principal theories or doctrines 
of diseases, that have been taught at different 
periods, by the chiefs of the medical schools, 
and by the most eminent authors, I should 
now proceed with my proposed attempt to 
establish a more correct and satisfactory 
theory of fever, than any that has hitherto 
been made public ; but after a more delibe- 
rate consideration of the subjeet, I have con- 



eluded to postpone its publication, until T see 
what reception the preceding observations on 
the theories of "others, will meet with from 
the profession. If the reception should be 
favourable, it will encourage me to hasten 
the publication of the theory which I have in 
contemplation ; and although I have no pre- 
tensions to superior discernment or ingenui- 
ty, or to the profundity of erudition of many 
of my predecessors or eotemporaries, yet so 
many facts have been accumulated in this 
inquisitive and enlightened age, and so many 
improvements have been recently made in 
different departments of science, that 1 hope 
I shall not be thought inexcusably presump- 
tuous, for supposing myself qualified to es- 
tablish a theory of diseases in general, and 
of fever in particular, less exceptionable than 
has hitherto appeared. 



FINIS 



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